29208 7984 1-OLKSIONt UK
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Building Permit Confirmed (�
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS �PIPING PERMIT
Date---4-- ---.-2'8._..._. 1977. Permit No...---./..�..��.P..............
The undersigned hereby makes application to the Plum ing Inspector of the City of San Jose
for a permit to install/pl ra nt�♦tr vrfate eoC Mn Ifor on the reverse side.
Exemption from ra Gira nt for tete%(C[(ifo/ nie for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement 'a
Undersigned attests that his Ste)jCalifornia�Can,,,,fJ�.tc,,C' e '�
is in full force and effect and properly �u for xe this ajs lstice n.
San Jose City Business License #
4.3
1 certify that in the performance of the work for which this ermit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER FEIC6'tESO
ADDRESS F Lot No.jorY
USE OF BUILDING " _ - .-
Signed ... .. . .._.... .K.+�' '- .----.-------
\ VAI. 's 02uSroM Z3atL. 7 Psot
280-401n
7ORL P01 I(STf1NF f1R VALS
2,61
FIXTURES NO. FEE MAIN DRAIN
Water Heaters / — Size IMaterial
Water Closets To IFee
Bath Tubs RAINWATER DRAINAGE
Showers Size IMaterial
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
Di5h W s er Size Material
Waste Disposals Water Fixture Fee
Wash Trays HOUSE GAS PIPING
Washing Machines No. Lin eOutlets 2
Water Treat. Equip. — Size Fee
Sinks FEES
Dental Units Fixture Fees /
Drinking Fountains Main Drain Fees
Floor Drains Storm Drain Fees
Hoppers Water S s. Fee
Sand Traps Gas Piping Fee
Urinals Surve '
Area Drains Permit Fee' �-
Water Leaders TOTAL FEE
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
Indirect Wastes Approved y 82
Drywall B
Backflow Preventer Partial
Survey Approved
Bpi ,1
Rodg .
TOTAL / — Approved
B
•( '? s uS sl Finish
Approved
By =t6AfiL(wltl;i)