79181 7643 Shadow Hill Lane
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
Date /�—Z ,J
APPLICATION FOR BUILDING PERMIT
, 19— Permit No.�
Application is hereby made for a perm;# to1-1
9 T
a sfory, TypeBuildi 9 Use Zone
a41Q Use
to be occupied only as 1�2re
n AO �7ly3z! dE0 OParking Space L
^_A41 na-le nl
in accordance with Plans, Specifications ani Plot-plan 1ila
Estimated Value of Improv em....
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manned so as to violate the workmen's compensation laws of California.
Owner K/ �'QI�� Address
ByCeiyST Addresz
RECORD OF INSPECTION
oundation /�-�2�73_Qiu-.�/` la-10'7
Stucco Finish z�27r7 �
7643 Shadow Hill Lane 7 R. Ames P
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