73690 1673 Galway J
Building Permit Confirmed L
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date. - / ------ ----------------- 19L Permit No. - ,---Q-.
The undersigned hereby kes appli atio to the Plumbing Ins for of the City of San Jose
for a permit fo install lu in {' u o es B` n verse side.
Exemption from req uir� e�! n or's License is hereby claimed
by undersigned: as wner ❑ statement filed ❑ G
Undersigned attests that his State of Cali rnia Contractor's License # /v'/ �1 z
is in full force and effect and properly auth0 i a ap li
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
ADDRESS
USE OF BUILDING
FORM 280-30 10M 3/67 Signed---------- ' ---- rel.-!f1 '---------------
1673 Galaway Bohart
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size Material /
Water Closets Hoppers To To Septic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers / Urinals Size-F 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
Washing Machines / Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
)ental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
'aMal " �-� �' S•ui'�w '-7.�„Jy " . No. Lines Outlets Size'
tough �i_9_ J /c „ •/ Tested and Approved