6696 7928 Wi0balark Way
Building Pormi} Confirmed ❑
Not Required � 9
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING]PERMIT
Date--------------------I---/ ----. -- 19.7.3. Permit No.--------------b-_Q?p .
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed (]��./ 3.7
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly authorizes This application.
San Jose City Business License #-4,q
1 certify that in the performance of the work for which this Parini is issued I shall nqT employ
any person in any manner so as To violate The wor 's tompenzafion laws of Californi,y. �
OWNER CO yL /Z- c=A e, Met
CS/ O
ADDRESS 7 c92-.r8 Crloo U r_H o f w 0l�l .
USE OF BUILDING 2 S
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Signed--.� -- --(�
280 30
7928 Woodlark Way Ace Plimhinrr
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