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W �k OF SAN JOSEk/ _7�' BUILDING DEPARTMENT
A P P L I c A;T2?1e 0//'N5r F0k_ BUILDING PERMIT
................ 19. Permit No._.3_.73__t.7---------------
Application is hereby iide for permit to4��� -------------------------------------------
a......_/
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Typ� .................... Building
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a........ -----story, ------ V.......
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at
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to be occupied only as —---- ----------------
in accordance with Plans, Specifications and Plot-plan filed herewith.
1�
Estimated Value of Improvements, ---------
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 Calif
"or
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Owner -t-�O Address//��'�-'r: "
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BC-----...Addres ----------------------_---------- --
ZoConfractor, ant
Form 280-1
RECORD OF INSPECTION
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