21535 1228 tJ15PELL PLACE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date---S.. Z-T.....................-....... 1976.. Permit No.-----1�.c%-5..3s-------------------
The undersigned hereby m kx?a plica}ion to fha lumbing Ins c or of the City of San Jose
for a permit
to
ins}all plum n i es a ' }h se side.
Exemption.-from require en} ete ali orn a f r on raci s License is hereby claimed
by undersigned: a owner ❑ statement filed ❑ /7/ - -7
Undersigned attests that his State of ,Californi onfrac}or's,License #'
is in full force and effect aneily eu}horize�
/!
' +• '
San Jose City Business Licenseicense #-t.
I certify that in the performance`of Hhe work for which this permit is issued ls6rr not employ,
! '. any person in any manner so as-fo violate the workmen's compensation laws of California.
Skncr OWNER �P6,JELL
' S4go
ADDRESS CLA<< Lot No. Z(;
USE OF BUILDING/— 12E4
er
280-30(9-731 Signed-----L-+.uu!u'c`
1228 RITPPFTT., PLACE CENTRAL
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