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PHONE 2]]- 58I. - y
r¢ I._'sw`. Building'Permit Confirmed ❑' �''�
v y.Not Required ?,r' ❑
CITY''OF SAN JOSE BUILDING DEPARTMENT
APPLICATION iFOVIRLUMBINGand/or4GAS PIPING PERMIT
Date._, ...........- . ..... 19,�Permit No. � 7s - ....". ....._ }'
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The�synde'rsigded •,hereby makes,.,applicatiori to the Plumbing.Inspector of the City 'of Sen.Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for.Stale of California for Contractor',' License is hereby claym'ed- ..
by undersigned:- as�;o-caner ❑ ";iatement filed"❑�J a
Undersigned attests that his State of California Contractor's ILicense # ✓/�-3��` ,,
is in full force and 'effect and properly au1 es.th' a!plppica�ion.
San Jose:Cify Business License'f.# ' 70�
Q I certify fhat'in fhe performance of the,•ywork for which this permit is issued I shall'not employ
'f any person{
OWNER
ADDRESS waLd` Lot N°'
•4' USE OF BUILDING
i-
Signed F". .t...ea.../ ......................
2B0-401N
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