3568673
CIT O �PL, k C �e . �>` 27
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT_
Date--------- ----------------------------------------- 19... .... Permit No. -S
Application is hereby made fora permit to ...g�.,'.........................................._/...
a -------- 1 -------- story, Type---- T ..... er..S.L:IC-nC.f------------------------------------------------- ----- Building
at ----11-3-b ... . ..AAD
to be occupied only as -----
moi. y.....
in accordance with Plans, Specifications and Plot -p, gid7 h ,V
Estimated Value of Improvements, $......../..c -n,? --------------- �/�C
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violate the workmen's compensation laws of California.
Owner
da.C...... Address --- /°-1r.5.-..----'5=
BY�� /'?Cg C/!�¢&✓Lit:. - ........ '--.Address ---- Y` `-`J-e -------------
Conii c+or, Agent
Form 280-1
RECORD OF INSPECTION
Foundation K—Ge�����
...............................................
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