41176 (2) CITY OF SAN JOSE
BUILDING DEPARTMENT
APPLICATION FOR BUILDINP PERMIT
Tract No:27�_9_7-_f... Lot No.4f--- .........
Date------ ------------------------------------ ..... 1PIftrmit No. ---------------
i
Application is hereby d I a permit --------------- ... ....... ...
_made a I&r ...
a-------�___ story. Ty . . ...... ---- ... ... .. .. ------------------- ............. Building
at�7.401- - ---------------------------------------------- Use Zone -..............-----..
at
i...--------------
in
... - --- ----
40" 1-1
to be occupied only as Zlf7--- X& ce ! -----------------
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements,
a San Jos
It is hereby agreed that the requirements of th - - - YBui ing and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of Son Jose, will be
complied with.
I certify that in the performance of the work for which this Permit is issued I s not employ any per-
s in
any m f i lot the workmen's compensation laws of Californi
on
.... ............
r ��Adclress/ .":� .. ..... .....
............
OW
B;cn Address -- ----- ------------------------ ---- -------------
A --------------------
Form 280-1
11 RECORD OF INSPECTION
Foundation .... K R w a � ' �
Stucco -------—-------------------..------------- ---- Finish