21101 7493 MOLTZEN DRIVE
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE" BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date............-�---�----------------------- 197.6. Permit No.._-------------- -..
The undersigned h a 1' ion�ST)IS�PI Inspector of the City of San Jose
for a permit to insta s r e n the revorsa side.
Exemption from quire t for a!e of California for Canfractor's License is hereby claimed
by undersigned:( /�//Ves owner !t V J statement filed ❑ / 7/S��
Undersigned eftes}s theft his State of eli nia Con c r ie nse
is in full force and effect lend properly a t t �� 'i t' ( /
San Jose City Business License
I certify that in the performance of the work for which this permit l�I shall not employ
any person in any manner so es to violet' the workmen's compensation laws of California.
OWNER 1kGrx1LcL
tkAc.t ADDRESS -74 Ct � � o k-I- .Gnl � /t Lot No. 9
sego
USE OF BUILDING /2eu
/J1/Z�1Gt.� Co/.�.�.'s.Cf1 A.,. Q.KC.r.........
280-3019-73) Signed ....0 - �...---t...---,.....
7493 MOLTZEN DRIVE CENTRAL SERVICE
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