23361 Cat 9 1025 TUSCANY PLACE
PZ-41V Building Permit Confirma
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------------8 -/�---..... 19.741/ Permit No.--2,..---3,3--,/;z--/---------
The undersigned hereby me s application to the Plumbing Inspector of the City of San Jose
for a permit to install plumb' g ' It aye d�pthe reverse side.
e
Exemption from requirem f ni =tractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ Cl C7
Undersigned attests that his State of California C is U& 7 Il
is in full force and effect and properly euthorixas this ufion.�y O 4C1
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 soasto violate the workmen's compensation laws of California.
OWNER Fo&/IefOSf1 f/O.r/fS :rY3
ADDRESS 025 TUSCA// Y �LACG Lot No. 9
USE OF BUILDING Res/Qe�t/C�
- -280-30(9-73) Signed e L-0-------------------------------------------------
1025
D1025 TUSCANY PLACE CROWLEY
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