12283 (2) 75 S BOLLINGER ROAD
Building Permit Confirmed ❑
Not Required ❑
CITY. OF SAN JOSE BUILDING DEPARTMENT
/' A•P�P�L�IC/ATION FOR MECHANICAL PERMIT
Date ll.:T8b.ek.b...................... 1916, Permit No..........� -?�G-----......
The undersigned hore
Is kes app cation to the Plu Bing sf�eStor of the City of San Jose
for a permit to install the m cha s ed } r v so fe. J
Exemption from require a } i a fo r c�of s License is hereby claimed
by undersigned: as own r statement filed K
Undersigned attests that his Sete of Calif. nia Contractor's License 79 7
is in full force and effect and properly authori this applicatio
San Jose City Business License # �g
Icer}ify that in the performance of the wor for ich #his permit s issued I si of mploy
any person in any manner so as to violate the workmen's compensation laws of Californ e.
OWNER--7 �S
ADDRESSa Lot No.
USE OF BUILDING
Signed.- �M�TA7 - ..
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