40898 (2) �688
CITY OF SAN JOSE% BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tract Lot No� ------------
Date----------- -------------------- ---------- l9a, 10- Permit No. cc - - --------- - -------
Applicationis herr made for a permit f
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T Building
a---------/-.story, y - -- ---- - - - - -- -------------- ------- ---- ---- --------------- ----
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at ------✓
'_ ---- - - Use Zone
- - ----------------- -- --- Occupancy ---------/-----------
to be occupied only as Par i pace ------Z^'_
ati----- Pa 1 Pa'
in accordance with Plans, Specific- -ions nd(!!5�of-plaet_le�w
Estimated Value of Improvements,
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It is hereby agreed that the requirements of the Son Jose )uilding and Zoning Ordinances and all other
laws applicable to the construction, lo,cafion, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not onniploy any per-
So , -s of California 1�
an�,man,6,. compensation la j &V/111
Address/ - ----- w --- --
C n n.,
-- ---- ---------- ---------------
A� Address
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Form 280-1
RECORD OF INSPECTION
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