8906 1478 Primrose way
Building Permit Confirmed ❑
Not Required '--
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
Date...`'.-..L. ........................ 10(/ Permit No.-------------- ---------
The undersigned hereby mals latro PI m g In3� or of the City of San Jose
for a permit to install p 6i Q��kGyFjla(TdpgS/sserl��ri reverse side.
Exemption from requirement foAtaie of California for Contractor's License is hereby claimed
by undersigned: at owner ❑ _ state efiled l'�3�
Undersigned attests that his State of Californi tracto'e
c s
is in full force and effect and properly authorizes h s pplicats n
San Jose City Business License # Lzg , ` -4 ,4 XYZ
I certify that in the performance of t e work for which tis permit is issued I shall not employ
any person in any manner soas to violate the workmen's compensation laws of California.
OWNER , //(�Agzy i� t/' t
�� � r rn n c 't 1 _)A
/ Lot No.
ADDRESS
USE OF BUILDIN67:)?��S I1 )
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1478 Primrose 'I ace
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