4605716B s6pto_W>6r
CITY OF SAN JOSE
APPLICATION FOR
BUILDING DEPARTMENT
BUILDING PERMIT
Tract No.......................Lot No. .......................... 7
Date . ----......-"-2- 3-' -- 19.('_)..x.... Permi+ No....... -. ......... ........
Application is hereby made fora ermit to ........... �f�................. o.......... ................
a .......... /....... story, Type. ------- -'�p�.. /� j�y(f�� �.o PooiJ.
-- ------ ti rte✓.- ...... Building
at %.Q..l.-q.
$ e f e , 1� l7� Use Zone--.---�:..%..
�pancy...--...................
to be occupied only as ...... p --- rda.---�1�i g Space ........................
in accordance with Plans, Specifications and Plot -plan filed herewith.
Estimated Value of Improvements, $---..--... 2e. O--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 person in
any manner so as to violate the workmen's compensation laws of California. p .�� p
Owne --..................Address20.. .`f.�.- �yr�"r�`�--'&.!"------
%,onrracroy>e
By Agent -��.CC`--'''Y'
1019 SPDtember Wm Skoki:
RECORD OF INSPECTION
:EM
Form 280-1—IOM-12-63
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