39693 7567 PEACH BLOSSOM PHONE: 2]]-4581
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
3
Date_. ........................ IA.:.�.. Permit No ...o!-lj....(................. ---------
The
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the undersigned herebypry1akes`appl'cafoo to ilte/Plumbin2pinspecfor of the City of San Jose
for a permit to install plb�g));�ixtur s nal or pipes4il�sted0on�he reverse side.
6empfion from regwremenl s+or Stale of California for Confracfor's License is hereby claimed
by undersigned: , as owner ❑ statemenf filed 37
Undersigned attests that his State of ,California Confiacfor's License
is in full,force and effect and properly UR'ii th plicafio ./�'�,, w
San Jose City Business License # C/f/ S(`T�f'�rj//
❑ I certify that in the performance7of the work for which this permit rs issued I shell not employ
any person.
OWNER �
ADDRESS /��� /CLoGfi�D/J79 Lot No.
USE OF BUILDING v
Signed
eGU�t� _% ...
.. .. ,
280-401N
7567 PEACH BLOSSOM ACE
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