19544 (2) 6275 SHADY GROVE CT.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--------------------- ---/ ------- 19.?` Permit No:-.-- 'y`ry -----------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtu s a / 'pas 'st A X7"
de.
Exemption from requirement fo e/ fi i o cense is hereby claimed
by undersigned: as owner statement filed
Undersigned attests that his State of California Con actors License # J —y7-5
is in full force and effect and properly authorizes this ap
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shat n employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER )'K/C ,-�
nK/G/�
ADDRESS 6224— c i Lot No.
USE OF BUILDING h 1
280-30(9-13) Signed ---------------------------------------------
62
--------------."'-------------.
6275 SHADY GROVE CT.-,e-, 9R2 7 S //2L-ARRY,%J,PR,9G Z71 2 / 90 r73
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