8853 672 Stendahl Lane
Building
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CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date---1- ---Zv'---~ - -------- 19------- Permit No.-------T— ............
The undersigned hereby k s�a a ' n 16,y�PlymJsinf actor of the City of San Jose
for a permit fo install plu as a rovers. side.
Exemption from requirement f State of Cali ornie for Con}rector's License is hereby claimed
by undersigned: as owner ❑ s�tat,eamaented JS..�
Undersigned attests that his State of Calif ecigrFyS,l
is in full force and effect and properly authori } epplic i
San Jose City Business License $�' 2
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any me er so esyt violate the work m n' compensation laws of California.
OWNER� � K 7 /J.-[�4J /5 y!y
ADDRESS
�i 7 Z Lot No.
USE OF BUILDING G S
280-30(943) Signed... --= 'J---- --..._s-i-----------r -------....
672 Stendahl Lane
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