18209 978 WESTLYN WAY 43 / �t��
�� �AW44WVIV ilding Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE 1 BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL
���99PERMIT
Dafe--,C y ---._.......__.......--.- I � Permit No..._I--- - �-----
The undersigned hereby mikes application to the plumbing Inspector of the City ofrSan Jose
for a permit to install fh�mer e �I- ori f onr}h5reverses� e2
Exemption from regs(irert�on� rs;i e o �Cai oorrnp/ iCoCrecfor's License is hereby claimed
by undersigned- Towner ❑ s" statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes is applicafion.,/�
San Jose City Business License .# (�? L/
I certify that in the performance of the work-f.+ w ich this permit is issued Ishal snot mploy
any person in any manner so as to violafe the workman's com pensefion laws of California.
OWNER
GJ
ADDRESS Lot No.
—
USE OF BUILDING
Signe--�-�<��=-�4�%�
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