2692 (2) 1159 KENTWOOD AVE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.----�... . !` i o ._ ---C/s ... ..........
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures en or pis listed on the reverso sid
Exemption from requirement for State nie fo nn��Acj�.e claimed 7
6y undersigned: as owner �d's LZe i#
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 # /77
I certify that in the performance of the work fo�this permit is issued I shall not employ
any person in any manners as to vi late the workmen' compensation laws of California.
i'
OWNER
ADDRESS Lot'No:
USE OF BUILDING /
7 /oj
280-30(9-73) ne .._ .. -- '- ------------- -- _
1159 KENTWOOD AVE ACI 5-D
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