77892 1661 Galway
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING nand/or GAS PIPI G P MIT
/0.-.-... .. ------------- 194/7— Yermi+ No....7����
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install u I r a e e reverse side.
Exemption from r r lif rector's License is hereby claimed
by undersigned: as owner ❑ statement
Undersigned attests that his Jj�Lfaf. of California Contractor's License
is in full force and affect and p1b ixe �a�lia^ymf�
San Jose Cify Business Lice /(jl
I certify the the performance of the work for which this ermit is issued I shall not employ
any person in y anner so as {o violate ih r4men's corrLpansation laws o4 California.
OWNER
ADD S _/fo Z/
USE OF BUILDING —a
FORM 280-30 10M 1/6B
Signed....... --- -- -- ----_------- ----- ---- --------_-----
1661 Galway Servisdt
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size FMaterial
Water 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 (j Q
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee i Q �—
Mental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
DOn1Ol - No. Lines Outlets Size
tough Tested and Approved
' v