13272 (2) 6276 SHADYGROVE CT
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL 7PERMIT
Date---.��./k --- 4v.............._.... 19;1. Permif No......./j... ..1..-7�......---
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install the mach r ad r ,�j'yi q{i�
Exemption from requiremer rni -(q-r nir s/License is hereby claimed
by undersigned: as own ❑ statement filed ❑ A
Undersigned attests that his State of California nfra ctor's License
is in full force and effect and properly authorises f s a¢pllcaIion /V V x
San Jose City Business License #__jQ.Z/,4
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 Oz./. 4 ,ee
ADDRESS0 'L fH4t� �?vc�YC if 1 .TLot No.
USE OF BUILDING 1
Signed,..r//�/�v�.:`f3'�/,'./.-.1�/ .fi.%tiL-----
280-20 �/ />i9!/drla>�/, i7y p19�
,6276 SHADYGROVE°CTkJ '? ANDERSON .HYDRON ,'G'`' '�" W/� /�'ylt4 'e�
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