35353945 ROSE BLOSSOM DRIVE
CITY OF SAN JOSE 9
APPLICATION FOR PLUMBING and/01
Building Permit Confirmed
Not Required ❑
BUILDING DEPARTMENT
GAS PIPING PERMIT
Date ..... Tti1 -.L_.Z �,53.-S-3
___......------. 197�i. Permit No..........- ...........
The undersigned hereby makes application to the Plumbing spector of the City of San Jose
for a permit to install pi a to he reverse side.
Esemption from req u o if e r onfracfor's License is hereby claimed
by undersigned: as owner statement filed ❑
Undersigned d attests that his State of California C �yctor' icons
is in full force end effect and properly aufhorixas th' ice t'
San Jose City Business License #
I certify that in the performance of the work for which this permit is isst4d 1 shall not ygmploy
any person in any manner so as to violate the workmen's compensation laws of California. '4
OWNER mie- w 415 MKNT •(
CKP"77'�
ADDRESS 9y5 ,eoSE BLOSSOM Der Lot No. 15
USE OF BUILDING 41551 ENGE /�j
Signed ... / .._ /C ---------------------.
945 ROSE BLOSSOM DRIVE R,
280-401n
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