174237489 ROLLLNGDELL
CITY OF SAN JOSE
Building Permit Confirmed ❑/
Not Required I]
BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe------- _...--------/0.7-3------------ 19.1,}_ Permif No......... L.T-/--L5........--'`..--..
The undersigned hereb akes ap licetion to fhe P m�7iinng II9p�pfor of the Cify of San Jose
for a permit }o install p mb / li}/�`G averse side.
m
Exemption from re i r at a rno on rector s License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigne& attests That his State of California C99�r�e<for's License # 7� % `-�
is in full force and effect and properly authorizes thiVapkdeatio
San Jose City Business License # t(
I certify that in fhe performance of the work for which this permit is iss.edT shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER .S//+'l 1"75 .9
ADDRESS 7/5�-2 Z�01A/'- 9/L Lot No.
USE OF BUILDING A /
280-30 (9-73) Signedy---.--�i------- .----------
O
7489L 91-LkNgDELL
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