9580 7643 Shadow Hill Lane-
Building Permit Confirmed
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMITA
Date.t-//-l_---L-y............ --------- 19.&3Permit No.----------z
The undersigned hereby makes appjication to +ha Plumbing Inspector of the City of San Jose
for a permit To install the mechanic wor li e hd se , //�J��
Exemption from requirement for e o o tfaCs6r 1' iais hereby claimed
by undersigned: as owner ❑ {s atement filed ❑
Undersigned attests that his Stafa of California Contra or's license
is in full force and and properly authorizes this app)(c tiasr—
San Jose City Business License #
I certify }hat in the performance of the work for which thss permit is issued I sKall not employ
any person in any manner so as to violate the workmen's compensa}ion laws of California.
OWNER Ze�� Gl l� Xi%Z G �lglyi,S
ADDRESSZ� 5;:,"1 Z,{,; Lot No._
USE OF BUILDING
Signed. .
zeo-zo (e.73) eCeS,v�
7643 Shadow Hill Lane ACCENT PZ/�iwr
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