86786 :::7647 Prospect Street
Tract No. �¢ Lot No. /
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date ,r/1- , 19 7S Permit No. VD7(( (¢
Application is hereby ma for a arm* t
a story, Type _� �✓' ^� ��' n Use Zone
at r. r > � � Occupancy
to'be occupied only asin ace
in accordance with Plans, Specifications and of plan filed herewith, =ace
Emer. Elect.
Estimated Value of Improvements, $ �S- 7. 00 .
I certify that in the performance of the work for which this permit is issued I sh 11 f p1¢p any person
in any manner so as to violate the workmen's compensation laws of California. ff i-O
Owner /l41/0 T Address -�-
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���✓ RD OF INSPECTION
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