85388862 Ferngrove
JBuilding Permit Confirmed ❑
v Not Required IL"1
CITY -OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date........ - --��-------------
------------
..._....--- .......----�� -�5�as
The undersigned hereby/m�� a ing Inspector of the City of San Jose
fora permit }o install plu bi ur a es ed on the reverse side.
Exemption from requirement for State of California for Contractor "license is hereby claimed
by undersigned: as owner ❑/J
Undersigned attests that his State of Ca iior a Con sac ors is se
is in full force and effect and properly authorises thi,�peS97l�ation.
San Jose City Business License $k
I certify that in the performance of the work for which ibis permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER I&
ADDRESS Lot
�� ��>�D ✓F Lo# No.
USE OF BUILDING RFS
i80-30 Aug. 69 Signed
S
862 Fernqrove Ace Flumbinq erce
TOTAL FEE
HOUSE GAS
No. Lines Outlets Size
Rough Tested and Approved
Finish ?�s_S—'f d By
FIXTURES
FIXTURES
MAIN DRAIN
Water Heaters
.Floor Drains
Size
FMaterial
Water Closets
Hoppers
To
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 Space
Material
Waste Disposals
Swim Pool
FEES
Wash Trays
Washing Machines
Indirect Wastes
Drywell
kFixtureee
ain FeeWafer
Treat. Equip.
Backflow Preventer
rain FeeSinks
Survey
ys. FeeDental
Units
ng Fee
TOTAL FEE
HOUSE GAS
No. Lines Outlets Size
Rough Tested and Approved
Finish ?�s_S—'f d By