26586942 FORT BAKER DRIVE Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGPERMIT
Date............- '/.(y ................ I�.7 Permit No....... .��.! 0.....�.a.---'--'---
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install lu 6i fi a s'e A e I limed on the reverse side.
Exemption from requ arrfn�P i'�sat9i%ary oririe � Contractor's License is hereby claimed
by undersigned: /as owner ❑ statement filed ❑ p
Undersigned attests that his a f' Calif ia/�Cy�lr o{s cense
is in full force and effect and prp�t�'utho, jfhif ep�pol b i
San Jose City Business License # (L2 7�Z
I certify that in the performance of the work for which this spermit is�ued I shell not employ
any person in anynner so as to violafo thee workmen's compensation laws of California.
OWNERehD��a ��O!
ADDRESS
USE OF BUILDING
Signed
Lot No.
2
942 FORT RAKER T)RTVE syCSU / /J �4 ACEOln
%G
al
TER DR
Material
Naste Di
Nash Trc
Kashin Machines 1 No. Lines Outlets
Nater Treat. Equip. Size TF.e
Dental Units
Fixture Fees U`ti
Drinking Fountains
Main Drain Fees
Floor Drains
Storm Drain Fees
Hoppers
Water Sys. Fee
Sand Traps
Gas Piping Fee
Urinals
Surve
Area Drains
Permit Fee
Nater Leaders
TOTAL FEE
trailer Space
INSPECTOR'S REPORT
iwim Pool
Gas Piping
ndirect Wastes
Approved
)r well
'" B
lockflow Preventer
Partial
urvey
Approved
By
L