19016 114o Kentwood -Avenue n
vl Building Permit Confirmed El
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date------------------00-------------------- 19.,.-. Permit No.---------------- /-------------
The undersigned hereby t� tlor of the City of San Jose
for a permit to ins}all plumb' p li t reverse side.
Exemption from requirem Waser
e o alio is for on rac}or's License is hereby claimed
by undersigned: ot C statement filed
Undersigned attests that his State of Californi rector
is in full force and effect and properly au}horizesp ica
San Jose City Business License #_ 4
I certify that in }heryo performance of the work for which this permit is issued I shall not employ
y
an person in any man7/ r so as to viola e the workmen compensation laws of California.
OWNER�!G'A4 c� rti
ADDRESS /�0 Ll / o Lot No. .
USE OF BUILDING /�. [/� //
280-30(9-73) Signed .- - -Sl.'../.L.lh/.----- ----- ..�)-- ---.L---
Dahl
� 1140 Kentwood ave _
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