13656 978 Westlynn
Building Permit Confirmed ❑,�
Not Required /❑
CITY OF SAN. JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
1 3 6,x-6
Date--------------------- --��---......_-- 19.7. Permit No.----------- - ---------------6...........
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixfures•and rPes J&ted 915fFe' vase side.
a/�f�Iy✓J" 4r9c+i((
Exemption from requirement iori5fata ef•Celiforriia for Con rectors bicenze is hereby claimed
by undersigned: as ownaz❑ statement filed ❑ 3
Undersigned attests ffe that his State of California Conh�ioLicense
<?�/is in full force and effect and properly authorizes this app�i<alion�
Sen Jose City Business License
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER (rv`E r ' /34`Z?W4C'iin--?Tn/fJ P61116 (3/1
ADDRESS Y . (��5 T n/ ( ),go — Lot No.
USE OF BUILDING -SA eI Nt T fi DT o
280-30(9-73) Signed--- ----------
978 Westlyn cardia
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