29086 (2) 6397 COTTONWOOD-CT
Building Permit Confirmed ❑
Not Required L�}�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.....--------�L!.'_.... .Z----..... 19------- Permit No...... P----
-----------------------
The
- 3....✓...............The undersigned hereby k p{'F o tl Ym mg eerfor of Idle City of San Jose
for a permit }o install plu b' {i p'gbs lfreverse side.
Exemption from requi ment State a if,I.,.-a or on raefor s License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his State of Cal'ornie dos}ract
is in full force and effect and properly aufh /(h[f7('4/appli o ev�kdf`//
San Jose City Business License #
I certify that in the performance of the rk for which this permit is issu I shell not'employ
any person in any manner so as to violate the workmen's compensation laws of California. /.
OWNEERRg ✓ *y /f� //fi/Y! C / / /� Ttl�fj /i /SPo�
ADDRESS 637 �m?f�vta, C Loo No.,
USE OF BUILDING— F
9P
Signed ---- -- -----
�.3��Silu-riP��o q�f 280T.401n
6397 COTTONWOOD L7fsd. 77FS A �vRP'GIx
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