97257683 Shadow Hill Lane
CITY OF SAN JOSE
APPLICATION
PLICATION
Date --(;a ------r 7...... ......
Building Permit Confirmed ❑
Not Required ❑
BUILDING DEPARTMENT
FOR MECHANICAL
-7PERMIT
.------19?1. Permit No......... -7,;7-S. _....- --.-
The undersigned hereby makes 9pplication to the Plumbing Inspector of the City of San Jose
for a permit to install the mechanical Iofk li dnqF.� rewj�rse)stdj
Exemption from requirement of CelifCrnia—f'o/G6rdrla df r'ense is hereby claimed
by undersigned: as osvn9r $j statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes this a�plic� n. ;?
San Jose City Business License # /�� �1//�
1 certify that in the performance of the work for which this permit is issued I shall ,nof employ
any person in a y-?)anner so as to violate the workmen's compensation laws of California.
OWNER
ADDRESS -768,?) —S4A-0&uJ tf t L.L l hf• Lot No.
USE OF
Signed
280-20
7683 Shadow Hill Lane Owner
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