18515 7536 rIOLtANMERRY PLACE v�/a!✓n
u RPermit Confirmed A
Not} Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR MECHANICAL PERMIT
Date........1.-. ............. 19 TPermit No.....
The undersigned hereby makes application to the Plumbing inspector of the City of San Jose
for a permit to install t N1n4ia wo�hste *e" h rt�i�e�e.
Esemplion from re—fr�'e i for SfSfe of•Celifornfa for CCnfractor's License is hereby claimed
by undersigned: as owner C statement filed C
Undersigned attests that his State of California Contractor's License #/�0
is in full force and effect and properly au Norizes�th'A`Sppli a ion //
San Jose City Business License`# � � jo —
I certify that in the performance of iha work for which this permiteis issued I shall not employ
any person in any manner so as to pi0late the workmen's- 4nsation Iof Celiforni e.
OWNER—E/f/�7-- /T//
ADDRESS 7 La No.
USE OF EZILDING
Signed ...---s --E� ...P.. ... ..pie-7'��`,� ----
7536 HOLLANDERRY PLACE &2 FY }i 4ftDERS
Type of B.T.U. Remarks (Check V)
Appliance No.. Input New Replace Relocate
Gas Ranges
Wall Heafers
Boilers ISfeam)
Boilers (Wafer)
Blower Furnaces
Suspended Units
Cl.fkes Dryers
FEES
Appliance Fee
ues Vents Fee
Flue Venf Hood/Ducts Fee
Hood/Ducf Gas Piping Fee
Condensate Drain Cond. Drain
Permit Fee ]i i
TOTAL FEE G
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete �/
Appliances/Misc. 7/ � Z 6
No. Gas Lines Outlets Size
Tested and Approved