Application for Mechanical Permit 1115 ROLLINnELL COMT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date......._..........----......-'-7--- 19-7 , Permit No.----------------------------- ----------...
The undersigned eb makes p' at' }o rPlum bin spec}or of the City of San Jose
fora permit to ms}af }h /a or e (s re a ida. y
Exemption from u 6 or a o C if r a or on}rec}or's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Califor recto ' Li s
is in full force and effect and properly author' es at pli
San Jose City Business License # C2
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 workmen's compensation laws of California.
OWNER
ADDRESS Lo+ No. jQ
USE OF BUILDING Siws.I S
t I
Signed----"--------'----'------------'----A---_..---------'---.._...
zeo-3o P.. 0. BOX 5ZG S iV.,. CLARA. CALIF.
7.7.15 ?0T,T.TNRTIFT,T, C(NTRT A,&.T VAT,T.FY
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