540481129 Yorkshire
Tract Nc,21-2c
CITY OF SAN JOSE
APPLICATION FQR
Date .l 19_
Application is hereby made for a permit
a _L story, Type
Lot No. �7-/ e V) 0
BUILDING DEPARTMENT
BUILDING PERMIT y O 4
Permit No.
to cc>vj-,—rCF—
Use
Zone
at 1111 L ez—c— �.z. _`i` Occupancy
to be occupied only as Barking Space
—
lot pelewth'rke Sprinkler
in accordance with Plans, Specifications andPg'ei=
Estimated Value of Improvements, $ / t d"' "
Exemption from requirement for State of California for Contracfor's License is hereby claimed by undersigned:
as owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License # /
is in full force and effect and properly authorizes this application.
San Jose City Business License # ¢ (OS g8
I certify that in the performance of the work for which this permit is issued I shall not employ any person
in any manner asto viol f? the workmen's compensation laws of California.
Ow�ne"r �,� 1/ wrlr-�: ��i/s2 rT r'Address /fin%i—f /Y
By �+�/ �l z- !'i�. Address
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