74696 898 FA-rngrove
G Building Permit Confirmed ❑
Not Required 4�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT ,
Dafe---------------- 196.e.- Pgrrnit No...........--r�...yl[. L----------
The undersigned hore� ion o Inspector of the City of San Jose
for a�permi# to install
p ing fixtures an or p�pos Iis4e on the reverse side.
Exemption from requirement for State of California fo ConIrector's Li ens is hereby claimed
by undersigned: as owner � e�e
Undersigned attests that his State o4 if ie Contrbctors License
is in full force and effect and properly aufhorixos this applice}ion.
San Jose City Business License #' �— /Q3�
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 4o violate the workmen's compensation laws of California.
OWNER �• L / TLEy n�
ADDRESS _P9��E/?/1/G�O vie ok,
USE OF BUILDING_ s
tic
Signed ACE PLUMBING SER!/ICE
FORM zeo-Bo IOM 1/e8 396Perryinouni 'C-orner-of Stone Ave.
San JosQI_California 95125
898 Ferngrove "F-eha,n7
FIXTURESRArea
TURES MAIN DRAIN
Vater s Size Material
Water Closets To To Septic Tank
Bath Tubs RAIN WATER-DRAINAGE
Showers Size Material
Lavatories To Curb To Main Sewer
Kitchen Sinks reaers WATER SYSTEM
Dish Washers, _ Trailer-Space _ " ' Size Materiel
Waste Disposals- ' Swim Pool - - `• FEE$
Wash Trays Indirect Wastes. . Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Prevenfer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE - 3 00
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough -" ' - Tested and•Approved
Finish By