24219 (2) , 899r MILLER AVENTIE -
` Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN-JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.....l------------ ----------------------------- 19------ 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 or Confractorz Li sa is hereby claimed
Cinfull
rsigned: as owner ❑ statement fi d
ersigned attests i is State of California Con ctor cense
-i fora ec e orl�u or es n ep c o i - is se
If
"v - Al f 111Wt
. -I certify-th the performance of the work for which this pa mit,is issued I shall not employ
any person in an ariner so as to violate the workmen'scompensation laws of California.
OWNER
ADDRESS IVI/ /off VJl Lot No.
USE OF BUILDING
280-30 (9-73) Signed---�-.c-------- -- tom./.8-- --..------------ -------------
899 MILLER AVENUE A7DAl /4M(Mt3uY� 5q
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