38217 ANA OF SAN JOSE t1V4�hTtj)-0 /y3f BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Date.�._Z�_6--------'P--------------- 19----1 ... Permit No..3�Z/Z-------------------
Application is hereby made for a permit to ff4,o------------------------------------------------------------
a------........story, Type--- ----A
r5MIKeOr--------------------- Building
at .......
to be occupied only as -------_----
in accordance with Plans, Specifications and Plot-plan filed herewith.
Estimated Value of Improvements, $.- /Ji. 3.e!e?----------------
It is hereby agreed that the requirements of the San Jose Building and Zoning Ordinances and all other
laws applicable to the construction, location, ancl,�`use of buildings within the City of San Jose, will be
compiled with.
I certify that in the performance of the work for which this permit is issued I shall not employ any per.
son in any me r so as to violate the work MA 5 compensation laws of California.
_ _Zt, /.. 5�.-.' dress/
Own -- --------- -------- I7
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-- .... ...Address -----------------------------------------------------------------
By- ---------------------------------.......-------------- . .
gopffactor, Agent
Form 280-1 1-04 Westlynn Way Euc.ene De _La Cri.-IZ
RECORD OF INSPECTION
LF,�,,d at -Z -Z
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