14073 (2) 6367 SLACKWOOD DRIVE
Building Permit Confirmed ❑
4 Not Required ❑
CITY OF SAN JOSE I BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL
PERMIT
Date //./!N(�L..-PS.51...... ... ._.. 19.7L. Permit No__/.1:..o.?/.........
The undersigned rab e p ios/ I c r of the Cit of San Jose
for a permit }o ins}a t rk o e '
Exemption from requireme for Ste a of Ca nia for Contractor's License is hereby claimed
by undersigned: es owner ❑ statement filed W
Undersigned attests ha} his State of California Contractor's License # 01 5091
is in full force and afPin ,
nd operly authorizes this application.
San Jose Ci}y Busis se J- WA 9-
I certify that in ifme a of the r f c ar i s �Caa
eny person in.any�aj� � a [,o violate 4 is woremen's compensation la
OWNER_S//fLX)_ o--�&�Ypw, . A
ADDRESS (O 310 7 Q. cJO Lot No:"
USE OF BUILDING Signed.H�Q�
- ILI¢>. .- - --'------- '
280-20 " Q
6367 BLACKWOODDRIVE DAY & NIGHT. SERVICE CO.
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