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BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT7_e*7y`04
Date---- .......... .............. 19--- Permit No.j_C_j_2.4----------------
Application is hereby made for a permit to ----- ------------------------------------_----_.
a--------/_----story, Type----- Z.Es...........................;;------------ ------------------------- Building
at ......93y--------la-6-S
4z_1 Wo,
to be occupied only as
in accordance with Plans, Specifications anal' 4Med/reow5s<4�
Estimated Value of Improvements, $.-_/Z -------------
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violate the workmen's compensation laws of California.
Ownerlejl�b 101_Au� __,4Z.✓--C.Acldress
od&_��ng._et---- --------------------Address ----------------------------------------------------------------
mt ter,
Form 280-1
RECORD OF INSPECTION
Foundation ----�./Framo .... 2
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