10563 7507 MOLTZEN DRIVE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date---------------------:97 .4........-------- --- 191 . Permit No.-..--.�� /------------------
The undersigned hereby makes ap cat* n to the Plumbing Inspector of the City of San Jose
for a permit to install e i or �to r • side,
Exemption from r 'for e o r onfracior's License is hereby claimed
by undersigned: as owner 11 statement filed ❑
Undersigned attests that his Stateat'�.4fa'fGrnie C�pQtr 1 #
is in,full force and effect and proper rzas t c
5a Jose City Business License #
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in any me nnar so as to violate the workmen's compensation laws of California.
OWNER T2Gti1E(-L
ADDRESS -7y-0 -7 M 0 L.T-ZFN �L Lot No. 11
Y4 Sea 1"6J
� USE OF BUILDING
Signed----CR!? I??� 12'e1G��1-�D.-�-�6?£------
280-20 16-731 _
7507 MOLTZEN DRIVE CENTRAL SERVICE
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