79583 915 Ferngrove Drive
Building Permit Confirmed ❑
Not Required Q•
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
for a h permit etog
install
are y ......a ttic 19_v�, Perl he aref� ----------- ------
Date. .
of the City of San Jose
p p reverse side.
Exemption from requirement f State of Califor�for Con act r' itis ereby claimed
by undersigned: as owner ❑
Undersigned attests that his State of Ca if m ontractor s License
is in full force and effect and properly au}horixes�jhis aceJi9rt��-//
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,.II�h�
ADDRESS
USE OF BUILDING
260.30 10-ee Signed .
915 K7&rmffiat Ferngrove Dr Mice
FIXTURES FIXTURES MAIN DRAIN
Water Heaters ,P Floor Drains Size Material
Wafer 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 Size I Material
Waste Disposals Swim Pool FEES
Wash Trays - Indirect Wastes Fixture Fee
:Drinking
Machines _ Drywell - Main Drain Fee
eat. Equip. Backflow Preventei Storm Drain Fee
--- a, i Survey_. - Water Sys. Fee - - -
nits +im SIE.J 1: ,w. v :,�.,,, Gas.Piping.,Fee
Fountoins Survey _
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial - No. Lines Outlets Size
Rough Tested and Approved
Finish By