95674 8069 Hyannisport
Building Permit Confirmed ❑
Not Required .--
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date_....--------...........----......----'- 19-----.. Permrt No.------ - "--"---
The undersigned he by m kes a plic 'on t he Pum g Inspector of the City of San Jose
for a permit 4o insfa p re / byre on the reverse side.
Exemption from r for at C i r Contractor's License is hereby claimed
by undersigned: es owner ❑ statement filed q
Undersigned attests that his State a alifor ' Contractor's Liycense #Z.3 7 C1 O 8
is in full force end effect and properly a his a ' . ` 7� /�Z)
San Jose City Business License #
I certify that in the performance of the work for which this permit is'issuod I shall not employ
any parson in any manner so as to violate the workmen's compensation laws of California.
OWNER fZ0/Sl v So v T F--
ADDRESS
'ADDRESS 9 //YA A/ v/S I'd rt.T 'D2 Lot No.
USE OF BUILDING E?
]9030
Signed PYye, ---
--------------------..
8069 Hyannisport Ace Service
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 Material
Lavatories Area Drains To Curb To Main Sewer
kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers - Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee , C!(t
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains i Survey
Permit Fee �,6
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough a Tested and Approved
rinish