42411 (2) AWOF SAN JOSlollinger Rd. BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Tract No. -------------------- Lot No. .............. ...- FLAT Frcr
i Pker-.
Date....----- .. � �'� µ
--....- --- 19-.�.... Permit No... c ...- --
K �1N N.p.—nye
Application is hereby made for a permit to ......(3 ----------Z,........ w'rN_.-MPML
� SrAucrua Es BIM'rs
a--......t.---.story, Type---I:SV.:.....A... 5` 4."r_.......... ... ....._-------p A,u..._---..._ Building
0 LL!013 Use Zone ........1`.Z......
Occupancy -------5.3--.......
to be occupied only as -------50PJ/k_- ----- cSFpoL G(/rSS gamParking Space ---------------------
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.........zoo V................ Z e tooa
It is hereby agreed that the requirements of the Sen Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per-
son in any manner so as to violate the workmen's compensation laws oalifarnia.
' f/JFST✓rILLE ,
OwnerUN.r€J..Ff�.s .y. .: �4- &VA4_?2dress / oVl ..... r_-Ie
Contrac { � -- // [F ... . ..------.....-----
-----.....ByAveat -- -------------------------Address
Form 2e0-1 6191 Bollinger Rd. United Presbyterian Church
RECORD OF INSPECTION
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Stucco ....... ---------- --------- ....
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