6347 7643 Shadowhills Lane
Building PaConfirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
7
Date---- ---=- --- ---- . 19��� Permit No.-------------- 3 -The undersigned hereby makes appli afion to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixiur es *f revivers
Exemption from requirement for rJ�VLYe�e is hereby claimed
by undersigned: as c ner statement filed i]
Undersigned attests that his State of alifornia Confracfor's License # ^ G�'r
is in full force and effect and properly authorizes this�appllat
San Jose City Business License # r ���/s
I certify that in the performance of the work for which is permit is issued I shall not employ
any person in any m/n so as to violas�e workmen's compensation laws of California.
OWNER ? Lf�/y
ADDRESS ! ' � !� r -F����--�/� Lot No.
USE OF BUILDING
28030
Signed -- l
f '� r ✓'ter.-.-..
7643 Shdowhills Lane Accent PIi mbinf?
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