38609 M -57
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
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Tract No. Lot No. ........ , z, /
Date...........................�73------------------- iqkz Permit No. d-+---------Application is or y e f a ---&rrl�2------------------------------------------------------
a--OY�;,n....story, Tye ---- -----.. ...... ,U", cqx----------------------------------------. Building
0� Use Zone ---
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Occupancy ------------------ ---
to be occupied only as ----GQP NUg pace ._..:._3—..._.
- -' -ns...a-n �)a�ti 11 a
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in accordance with Plans, Spe i d P
Estimated Value of Improvements, $ aa
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It is hereby agreed that the requirements of the San 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 perfcrmance 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 of California. 1 11 .
Owner— ..... ..... ....a4, -4ZV< Address
Contractor —'
Address
Form 280.1
RECORD OF INSPECTION
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\eco ................................ ... .........- ........ Finish
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