16011 (2) 7539 'K ngsbury
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date....---------.....-----b.l3a-----....."---- 19-7.5... Permit No.-----/. //
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 ❑ 2342$i
Undersigned attests that his State of California Contractor's License
is in full force and affect and properly authorizes this application. 4-i2379
San Jose City Business License
I certify that in the performance of the work for which this permit is issued I shall not employ
h any person in any manner so as to violate the workmen's compensation laws of California.
OWNER Wayne Tietz
ADDRESS 7539 Kingsbury Court Lot No.
USE OF BUILDING Residence 6FTmA6T R Tnc. '
280-30(9-73) Signed....------------------------------------------------
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