10563 (2) 7483' MOLTZEN DRIVE
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date------------------47-¢--------------------- 19-76- Permit No.-----1 ,-,Z3
, �G3--------------
The undersigned hereby ekes applica 'on To ha Plumbing Inspector of the City of San Jose
fora permit to install The e i li ,, — for aside.
Esampfion from requi ani fate o Ca rnw Con}racfor's License is hereby claimed
by undersigned: owner ❑ statement Filed ❑ _
Undersigned attests that his State of Ca ornia, Ccontractors License 7 1 S 7
i
is in full force and effect and properly aut r� e✓�s app (jJ7;n/�
San Jose City Business License # sAt"C�
I certify that in The performance of the work for which this permit is isscled I shall not employ
any person in any manner so as To violate the workman's compensation laws of California.
OWNER Ta Eoj E LL
wL� of TZ EN �/L Lot No. $
Spbo ADDRESS �74 93 �J�
USE OF BUILDING
Signed---- -------------
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2M20 16-731
7483 MOLTZEN DRIVE CENTRAL SERVICE
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