13581 6275 S2a dy Grove n
9 Building Permit Confirmed ❑
Not Required ��
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date
Date--- `-�'�-G `------I..8--------- 19.-/-S Permit No-----------------�--1--3-�(/...L.--------
The undersigned hereby makesa ipa#i n r bT.iri sp c# the City of San Jose
for a permit to install plumbing fir r on Vesicle.
Exemption from requirement for Stafe 91 California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of California estor's Li
is in full force and effect and properly auf orizes f do -
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 violate the workmen's compensation laws of California.
OWNER
ADDRESS �n :.7 l ��A �a rit �r Lot No.
USE OF BUILDING C- /
280-30(9-73) Signed--- - ---- .c=�---- »�"�y- "...----.-.....
6275 Shady Grove U Kajo
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