26618 (2) 6377 black wood drive
Building Permit Confirmed'❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date........./-- /3..................... 1927 Permit No......... C.95,
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The undersigne are y mak p' a}' to Igmb' s c r o4 the City of San Jose
for a permit }o ' iell u in ix or ,e�(s�J(s} on a verse side.
' Exemption f r or. Vat'
C ifo ie r on} aor's License is hereby claimed '
by undersigned: as owner ❑ sfafament filed 7
Undersigned attests that his State of California Contractor's License # J
is in full force and oLftsct and properly authorizes this application.
San Jose Cify Bu ass se
I certify }het in ance o w f y�i I4 ermi} is esu shell not employ
any parson in any nn r as f� at i w ruslen'>"EOm a tierP lee alifornie. '
OWNER I D /9S6A 6
ADDRESS /Lot No.
USE OF BUILDING ' n^ 7
Signed %/ L KhI/l�tl --->- ------------- ....: �/
?LAL�,40 ri
6377 BLACK'WOOD DRIVE S57 �/
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