17445 (2) 1172 ELMSFORD DR �e �Wp A(�l„til
Building Permit Confirmed '
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date.......4W ........ ---------- 197S.. Permit No.---------I.7_`f..-. , .7........
The undersigned Jreby m�6akes�a�ppli atios_t9 the Plumbing Inspector of the City of San Jose
for a permit to install 69116 i/ Iiyae .�jb-e,iwerse side.
Exemption from-require ant for tate of California for Contractor's License is hereby claimed
by undersigned: I/ as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #{ ,Q/7(�y�
is in full force and effect and pry erly_authori:es this application.
��#��.-� poi ice\/
San Jose City Business License T ^
I certify that in the performanoe/of the work for which this permit is issued I shall not am
pl
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER- i -
ADDRESS �77Z / mser� D Lot No.
USE OF BUILDING
Signed -” ...
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280-404n
172_ELMSFORD DR PIRNIK CONST
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