4867 (2) U1 IbMla
9 Building Permit Confirmed ❑
Not Required 's-1
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------- ----------------------------------------- 19.73. Permit No.------------- �-7---"----
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 Contrec+or's 'cense is hereby claimed
by undersigned: as owner Elstetaman+ led 7.7
Undersigned attests that his State of California Contractor's Li a
is in full force and effect nd roperly authorizes this applice
San Jose City Business Lice se # - _ f'j
I certify that in the p rfor ance of the work f ich his per i issued I shall not employ
any person in any manner o as to viol to t e wor e s m ns on aws of California.
OWNER
ADDRESS �^ Cu'�'A Lot No.
USE OF BUILDING n L S
q
380-30 Signed _..:.----------;,{- ....................
821 Lonna Lane Ace
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