40113 6681 BOLLIN(� ER .IROAD - PHONE 277-4581
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date..... ................. 19../1..`..�ernnit No.......
�. /... ....
The un rsignedhereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption fromrequirementfor Stale of California for Contractor's License is hereby claimed
,by undersigned: as owner ❑ statement filed ❑•
_ Undersigned attests that his State of California Contractor's License #
is in full force and affect and properly authorizes this application.
San Jose City Business License #
ElI certifyAat in the ,performance of the work for which this permit is issued I shall no} employ
any person, „
OWNER
r / .
ADDRESS —
USE OF BUILDING
. . Signed ..........:.......................-.................. ....................
280-401N
61 387 BOLLINGER ROAD ACE PLBG.
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