28030 (2) 11901 S. Saratoga-Sunnyvale Highway
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
D I Permit No.......Z...ffo...3---0........
- = -----195,gP ..
Application is hereby made for a permit to............
a.........x..........story, Type------ ...... --- ........... ..............Build*
.....................
to be occupied only as---'--.
in accordance With Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements. $.......�W'_0---()......
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other Ia.$
applicable to the construction, to use of buildings within the City of San Jose, will be complied with.
Owner- ddrpss............................__.......................
. .......
By..---'-
y .... ........ ..... ... ..........'-----'----------.....--.......Address........... ---...... -'--'---'-- -------------
Contractor, Agent
Form MI 11901 S. Saratoga-Sunnyvale Highway Rice
RECORD OF INSPECTION
Foundafion................................................................Frame.............................................................
Stucco....................................................-................Finish......
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