12886 84b 1jily Avenue
Building Permit Confirmed ❑
Not Required -4;1—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION/FOR PLUMBING and/or GAS PIPING PERMIT
Date--------------------------------------- ,)--- -- 19.7 ^ Permit No. -f' .1/. 7J
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The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑ � rilZ3 7 C— s �
Undersigned attests that his State of California Contractor's License # Q
is in full force and effect'and properly authorizes this application.
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall net employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER O �0 i � S k r
ADDRESS O y6 L I L Y /} V Lot No.
USE OF BUILDING 2E S
280-30 (9-73) Signed
846 Lily Ave
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