10209 7543 MOLTZEN DR
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING, DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT.
'+ Date......--------- --- ---- ----..... 19------- Permit No...............14 `1' -------..:.....
The undersigned (Iye�reby makes application he Plumbing Inspector of the City of San Jose
fora permit to iasf?,� Ir ped sn
} r arse side.
Exemption fro �9 en} r a o ab orni or Contractor's License is hereby claimed
by undersigned: Q as owner ❑ statement.filed ❑ 7� 9
Undersigned aftests that his State Cal' is Con act}Q s�'i nss
is in full force and effect and properly a 4 s t is � dpSibl/(,/
Sen Jose City Business License #a4
I certify that in the performance of the work for w ich this permit is issued I shall not employ
any arson in any manner so as to II
/v ° a the workmen's compensation laws of California.
OWNER �/1�_.,.rpXX �
Lot No. 13
ADDRESS
USE OF BUILDING S
Signed--- - - ---- --. ...--- -----
280-20(9-73)
7543 MOLTZEN DR PARKER S/M
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