19566 (2) 933 Miller Ave.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING. PERMIT
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.. Permi# No....LSG .--- - -- ----- --
The undersigned hereby makes application to {he Plumbing Inspector of the City of San Jose
for a permit to install plum bin fi�}ores and/or pipes listed {he reverse silo.
Eram }ion from re uiremen for Stale ofbllifol�ie for on actor's Licans hereby claimed
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by ndersigned: as we ❑ s{a en filed
U de ign t e +e f a Conira t is menseisin IIrcand op rl au ohis applic '
San Jose ity Business License # �✓-B-x-�L
1 certify t } in the performance o� work fo which this permit is issued I shall not employ
any person in ny manner so as to violaat-{he workmen's compensation laws of California.
OWNER 24/U�� c5
ADDRESS 133 ���L�2 �UE• T Lof No.
USE OF BUILDING
280-30 (9-73) Signe ---_.. .---------- -- .----.N'?- --t2---
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933 Miller Ave. Bradford Plbg.
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