40886 (2) 7584 F}tACi 8'LQS•SOM DRIVE: PHON E: 277-4581
Building Permit Confirmed ❑
Not Required -
CITY OF,SAN 1,10SE BUILDING DEPARTMENT 1,
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
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Date....-. ......__:..�.J..—.�......._...... 19..7.1 Permit No.........:_-f.L�-
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
r by undersigned: as owner ❑ statement filed El
Undersigned attests that his State of California Contractor's License #
is in full force and-effect and properly euthon�}rps }his a�p7plica}ion.
.'San Jose City Busines's License # ' U / c^' ��
❑:I certify that in the performance of the work for which this permit is issued I shall not employ/n
any person.
OWNER/Yl�/1�I �'r?RIi �' R
'ADDRESS- -7 TRY eh 'glo$ OC,"f DR Lot No.
USE OF BUILDING JJ p
Signed
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ned
. - 280-401N
7584 PEACH BLOSSOM DRIVE LUSTER' S TERMITE
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