23015 8139 HYANNISPORT DRIVE
Building Permit Confirmed 0—
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date. ------ 197 -. Permit No....--......Z-3.--of-�..-....----------
The and ersigned hereb(���rrr(/p4 p f b' ecror of the City of San Jose
for a permit to install ply/ """ s o a is} c reverse side.
Exemption from requirement f r State of California for Conlrac4or's License is hereby claimed
by undersigned: as owner C statement filed ❑
Undersigned attests that his Stara of C nt C c ohV V x—
is in full force and effect and properly a ofhis p � /F-+
San Jose City Business License #'
1 certify that in the performance'of the work for which this permit is issued I shall not employ
any person in any manner/ t�so as 4o violate theworkmen's compensation laws of California.
OWNER G Y]kl _ y_�454S
ADDRESS V 3 9 1 c DA-v--t Q Y Lot No.
USE OF BUILDING a/ S
280-30(9-73) Signed ... ..- ... ....- - - -.. ..... --------'
8149 HYANNISPORT DANE,. RFGOR
FIXTURES NO. FEE MAIN DRAIN
Nater Heaters Size IMoterial
Nater Closets To I Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To IFee
Kitchen Sinks WATER SYSTEM
)ish Washer Size Material
Vaste Disposals Water Fixture Fee
Vash Trays HOUSE GAS PIPING
Vashing Machines No. Lines � Outlets
Vater Treat. Equip. Size /' Fee I
Sinks FEES
)ental Units Fixture Fees
)rinking Fountains Main Drain Fees
'loor Drains Storm Drain Fees
HoppersWater S s. Fee
Sand Traps Gas Piping Fee 0
Urinals 5urve
Area Drains Permit Fee
Nater Leaders TOTAL FEE 1 3-.30.
frailer Space INSPECTOR'S REPORT
iwim Pool Gas Pi in
ndirect Wastes Approve
)r well IL /On zz--.
lackflow Preventer Partial
urvey Approved
B
Rough
TOTAL Approved
B
Finish
Approyed
B GPwltiu..