34464 1058 WEST LYNN WAY
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe-----_.....---------......_f./ --------- 197t Permi{ No------. K........`...
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbin i rJ�`en�/y°�jjip s.l'skedo. the�%� rze side.
Exemption from requira'r en iF re�$fTla of.�Slif� .far1C6s+W Licanzo is hereby claimed
by undersigned: es elvner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full.force and effect and properly authorizes this p lic' n.��
San Jose City Business License # y`d —0) ,
I certify that in the performance of the work for whiX--his permit is issued I shall not employ
any parson in any mannerp so as to violate the workmen's compensation laws of California.
OWNER lJ�CI f- P`fir
ADDRESS 60e 15-f/Y-oQ n U Loo No.
USE OF BUILDING �
Signed ..
280-401n
1058 WEST LYNN WAY iACE
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