54389 4 .
923 NOvember
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Da#e-8-- 7 , 19 6 7 Permit
Application is hereby made for. a permit to
a_I—story, Type. Ws i� . Use Zone _
at�'Z 3i a _ '� ,, �,/ \ Occupancy_Z
/ w'^ ] Parking Space 'L—
to be occupied only a , 1M-'�/
in accordance with Plans, ecifications and lo#- lan'filed herewi hr Fi a Sprinkler �—
Estimated Value of Improvements, $ � � �
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner so as to violate the workman's compensation laws of California. I
OW 40'YB et e�O� Address '727 /6t/tM2) ��-lde.
Address
ey' T -�Q R�ECO,R�jD OF.-INSPECTION
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