2800 1697, Galway
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLIICn/ATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.--...P..' ---..�.�.....------.......-- 19.'3.. Permit No..---....�."? -------------
The undersigned her eke ap 'cation to }hs Plumbi Inspector of the City of Sen Jose
for a permit fo installcov
u ix /or ip is the raverso side.
Exemption from re uu m n or a li o ni fo ontrac}or's License is hereby claimed
by undersigned: as owner statement filed 13
Undersigned attests that his State of i is C t .JJ
is in full force and effect and properly a `�'' this p r" o �
San Jose City Business License $k �.7 ^ V -1 411,
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any nner sso�a/to violate the workmen's compensation laws of California.
OWNER A-1 ti r 4! H Edda
ADDRESS �G q7 ���.ZutLC1 ��/✓ �� Lot No.
USE OF BUILDING
280.30 Signed ...- .- c------------F:U.r
1697 Galway ZSTERN
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Mafericl
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 7oE Fixture Fee ¢i
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
TOTAL 00 TOTAL FEE o�
INSPECTOR'S REPORT HOUSE GAS PIPING
'aHial No. Lines Outlets Size
tough Tested and Approved
•finish B
Y