70922 801f03 Mi Ave'.
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTM�E ,T
APPLICATION FOR ELECTRICAL P—E7RMITc,7J ?7';C j�r
Dafe----.: --------------------------y..------. 19----- -- Permif No.---....l..p--1-ct' ............
undersigned hereby makes application to the Electrical Inspector of the City of San Jose
r,• - for a permit to install electrical fixtures and/or wiring as listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests 4haI his tate of California CoPtra��for's License .#3On- c1-3
is i u force and affect and pr perly authorizes this ap ¢2 ion.
Sa Jose if Business Licena # 6 0✓7-
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ADDRESS
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