9053 7598 Shadowhill
BuildingConfirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--------- .^.. .�------------------- 192/- Permit No.-----....`_--- - 0_J-.S------------
The undersigned hereby makes a ng sp a City of San Jose
for a permit to install plumbing fixture a or pi ist th a rs side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of California C t s L'
is in full force and effect and properly eu} orize� }his / c n7
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 viol to the work en',en's compensation laws of California.
OWNER �� H d
ADDRESS �� do d cd L(/ Lot No.
USE OF BUILDING
280-30(9-73) Signed.,-- --..[---- - -- ----- ---- ----/ ---�- �r
7598 Shadowhill dado p1bR.
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