8623 906 September Drive
Building Permit Confirmed ,❑
Not Required L/
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date..../. '�. �". `J....------. 19------ Permit No......... 424 -3--------------
The undersigned hereby make -application to the Plumbing Inspector of the City of San Jose
for a permit to install the me nicaf o Psi /o o evAri s�!`//
Eaem piton from requirement-fo/r�5i of 0 i.,{orr rah 66?ars. is hereby claimed
by undersigned: as ow�r ❑ statement filed ❑
Undersigned attests that his State of California Contra' canfy�/ r !%��
is in full force and effect and properly aut orixes t is aper at io -
San Jose City Business License
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.
OWNER
ADDRESS E SEMS /F' �/i Lo+ No.
USE OF'BUILDING
Signed -----
280-20 ; -' �V,�,z ,
906 September Drive Foremost Htct.
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