28879 -7644 WEST HILL LANE
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBI and/or GAS PIPING PERMIT
Date_.. .. 19------.. Permit No. .I .....................
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbin urs d r eFJjsl�d n 1 r�varsa side.
Exemption from requirem t is fors License is hereby claimed
by undersigned: as
.or
❑ statement filed ❑
Undersigned attests that his State of California actors
is in full force and effect and properly authorixes 'fa plice`fjpy
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 m nner so as to x?olat the workmen's compensation laws of California.
OWNER
ADDRESS 74- Lot No.
USE OF BUILDING
Signed--- - -- ---. r..a..... ........
28Q�401n
7644 WEST HILL LANE CPIERCE%CROWN LEG
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