89579 870 Ferngrove I
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
'Date--.-..- ............... 19f2 Permit
�No------(J-The rdx,,i?z undersign h r y g a#/�o�fCe Blymo�ng Inspector of the City of San Jose
fora permit fo• ns r r d Yiste'd on the reverse side.
Exemption from raqu emenf for State`o�f�Cal(�ornie for Contractor's License is . reby claimed
by undersigned: as owner �Q /�� ;A+ �
Undersigned attests that his State of Ce rni on#ra o s is nse
is in full force and effect and properly authorizes this application.
San 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_/;g,.
ADDRESS 2 ,,0Lot No.
USE OF BUILDING Ae S'
28030 Signed ---L/L--/ � .J--- ......
870 Ferngrove C—/- Vischer_
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Both 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 Size2Fee
Material
Waste Disposals Swim Pool fES
Wash Trays Indirect Wastes Fixture
Washing Machines Drywell Main D
W°fer Treat. Equip. Backflow Preventer ° Storm Sinks Survey Water DentalUni}s Gas Pip _
Drinking Fountains Survey _
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REP( HOUSE GAS PIPING
Partial %?S 9/ No. Lines Outlets Size
Rough Tested and Approved
Frnrsh By