9314 1,018 Pemriing�on in. -�
Building permi# Confirmed Q
ry i Not Required ❑ -
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Da+ wOk...4P------------ ------------- 197-- Pernni+ No... --
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undersigned hp7b mmakeseapplicltior4#e�the Plumbing Inst/ fjr of the City of San Jose
for a permit to ins} If pluFib-�fi�rgSta_0 7410pi eistgd th=e�sferse side.
Exemption from req uveme for Sta a of Ifor is for Con}roe. ors License is hereby claimed
by undersigned: as owner o statement filed ❑
Undersigned attests that his State ofaQS�iwg this ontrpc#orj Lio n
is in full force and effect and properly�orims this ap(Ilii tffon/
San.Jose City Business License # �� .w
I certify that in the performance of # which #his permit is issued I shell not employ
any person in any nnar so as to i # the orkm 's c mpense#ilaws of California.
OWN
ADDRESS / J Lot No. `
USE OF BUILDING
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