38786 (2) Ilossom Drive
eIW70F SAN JOWc'
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date----------- ---`-- ------------------ 19...... Permit No. IS---------------
Application is hereby made for a permit to .....----------MRS-TRUCT----------------------------------
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'5 ;e
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a----1--------.story, Tipe------_4C. 0
- --------------------------------------- Building
�to be occupied only as SINGLE FAMILY. ;$9kJlgG1WDFN,#5 TRACT 2017
---- RESIDENCE
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, Ilie-5
.................
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the pc rformance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to vi.late the workmen's compensation let,,
.,6 afrrne, M,'
.10 Real
Owner ..... ........Address ---Menlo__PaTk,__UJlf o-rnia--------
DAvenport 1-7070
4!�......Address ----------------------------------
-----------------------------
By ----�nurz"
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Cofto, A)Wn
Form 280.1 t -anager
RECORD OF INSPECTION
Foundation A04-A
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