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A"OF SAN JOSE , , 4, 7 BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date '`' ..----------------------_' 19_� Permit
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Application is hereby made fora PerAto
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a- -/- - story, Typ -I � ! � .. ----------- ----- Building
at ez-
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to be occupied only av,.,-.,
in accordance with Plans, Specifications and Plot-plan fil th.
Estimated Value of Improvements,
If 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 i shall not employ any per-
i son in any men r so as t , I f theworkman's compensation laws f C l'If ia.
d 0 a' ,
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.......Address ........k�---- ----------------r T ..........
form 280-1
RECORD OF INSPECTION
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