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CITY OF SA ;�'VJYX�BUILDING DEPARTMENT
PLICATION FOR BUILDING PERMIT
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Appl- afton is hereb '
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------7.story, Typ _:.... .. .. .... ------. ..r----. .. - ------------- -- ----------------------------- Building
to be occupied only as �---— --------- .....
in accordance with Plans. Specificati s lot-4516rf trrxt�x
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Estimated Value of Improvements.. $ _/...... 7--------
It is hereby agreed that the requirement of the San Jose Building and Zoning Ordinances and all other
laws applicable tothe construction, location, and use of buildings within the City of San Jose, will be
complied with.
I certify that f i the performance of the work for which this permit is issued I shall not employ any. per-
'ry `/ a
c We'
in any I �As v'ollaf�fhe workmen's compensation laws of Califo a,,
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... . Addre4/ -- _- - ------- - - --- --------
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Cont,ac' Agent
Form 280.1
RECORD ,OF_ INSPECTION
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