68520-F 1104 Elmsford Avenue
Tract No. 31.2Lot No. �6
CITY OF SAN JOSE BUILDING DEPARTWhl�
APPLICATION FOR BUILDING PERMIT _
Date �S 19 7/ Permit No.
Ap kation is hereby made for a permit fo dAn -Io(d
a story T pedi71g .-use Zone _R
at (/V Occupancy
Parking Space
to be occupied only as _ �g Sprinkler
in accordance with Plans, Specificati ns an Can fil Emer. Elect.
-
Estimated Value of Improvements, Oa
1 certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner sgr as }o violate the workmen's compensation laws of Celiforb2���
Owner /C1/ �/l/ii/v�stI��' - Address l�
Address 2
npRECORD OF INSPECTION
Foundation <4` y� �1 17 Frame
Stucco - Finish _
1104 Elmsford K. Baumert �P/�
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