79592 I. 913 Blazingwood
Building Permit Confirmed ❑
Not Required 3X—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION 'FOR PLUMBING and/or GAS PIPING PERMIT
Date. --- ------ ---- ---... .1-- ------- 1911-7�.- Permit No.------ L-S/L--.�-.............
Th ndersigned h e es a plication to the Plumbing Inspector of the City of San Jose
for a permit to inste plu n pi on averse side.
Exemption from a or St o rryj r o actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests i1, his Sfafa f Ca' is Confrec rs License #
is in full force and effect and properI e h chis ap
San Jose City Business License `%JL(/
I certify that in the perfarmarc x of the work for which this permit is issued I sirall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER �/ G
ADDRESS0.,i
USE OF BUILDING
280-90 soae Signed _.- GriiiL:P-// '
d .
913 Blazingwood Ace
FIXTURES FIXTURES MAIN DRAIN
Water HeatersFloor Drains - Size FMaterial
Water Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size
Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer SpaceSize Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dantal Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee a,
TOTAL
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Ouflefs- Size
Rough Tested and Approved
Finish By
//O 3 /'7/6 9 Y c.h=. .