6636 (2) 6169 Shadygrove
Building Permit Confirmed ❑
Not Required •^'��
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date....................................1
--......------... /2- - -3—......... ---- 19. 3.. Permit No.------------------------------------------------
z K56
The undersigned hereby ma ppli i f the Pl;mbi" actor of the City of San Jose
for a permit to insfall plumbi a reverse side.
Exemption from requiremen or tate o Ca i rnie for ntrac}or's License is hereby claimed
by undersigned: as owner ❑ statement filed El
Undersigned attests that his Steof Celifcfor' n $k Zb' C 3 �.
is in full forte anddeffect and properly
as y aufhorixesa lice
San Jose City Business License # /{Y U 3 `f/
I certify }hat in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER SPEcTC/L C .
ADDRESS 6 2 SHA D y C2oyz nR Lot No.
USE OF BUILDING CS nn
280 m � Signed . 1� 2 ----�----- -°e-
6169
.✓----.
Shadygrove ace
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