54545 (2) 1019 Pennington
Tract No. Lot No.
CITY OF SAN JOSE BUILDING DEPARTMENT
p APPLICATION FOR BUILDING PERMIT fid _
Date /\ �� /Jp , 19 6� 7 Permit No. J_
Application is hereb adeefor permit to—, _/-
a_?storyype "wilding E 5 Use Zone
at //ll9_ T S � Tn / 1`�TH 57VOy'belupancy
to be occupied only as � M X80�/�� Parki 9Pace
C i Fi Sprinkler
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $
I certify that in the performance of the work for which is issued I shall not employ any person
in any manner so pp/_. s✓to violate the workmen's compensation laws of California. ,
Owner . 6 ,.�o�7T Address 1O/9G� �✓, �G>o./A ' f.'
By J(/tir r , T Cr tY� �� Address
RECORD OF INSPECTION
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