24218 905MILLER AVENUE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-----/U......--6-- ........_--..... 19 4- Permit No....../7...:C.�'4- -----------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbi g fiztures and/or pipes lis n the reyersa e.
ption from requirem f foc State of California for Co }ra Fors Lim i a cl i s
by nd r.ig ned ^ l as owner . "or s } an} fi
Under ig a e o{}, e i to a ifor is Conk s nse
is'�i full and rop ly eu oozes #his'epplieation.
San Jose C} Basinoss'License
-P6JGf
I certify fhh# in the performance of the work for which Vis permit is issued I shall not employ
any parson in any manner so as to violate the workmen's'compensation,laws of California. -
OWNER
ADDRESS 9ys M711 Pe iYye Lot No.
USE OF.BUILDING �c QSIC�PiY!
280-30 (9-73) / Signed -- -------------------------------------------'------ -------- / ---- --------
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