14054 8165 hyanni.sport n
`Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
S l Flo S'
Date- -- �� ------ -----------..d�-._-------- 19��Permit No.----------------. _....---------------
The un ersig ned herebyM. �frt.Pfe
at' pector of the City of San Jose
for a permit to ins}all plum o he reverse side.
Exemption from require o Cali oria for Contractor's License is hereby claimed
by undersigned: wner ❑ statement filed 0
Undersigned attests that his Wyaeferwalifer 'Jra��}To/r s en�se/ J Y`
is in full force and effect and prop rl
San Jose City Business License
1 certify that in the performance of the work for which this perrSi if is issued I shall not employ
any person in any manner so as/to violate the workmen's compensation laws of California.
OWNER
ADDRESS /' rrS O Lot No.
USE OF BUILDING a S' -
FRIF)'; ...
280-30(9-73) Signed --- - -
RINn -e -
va
nisrort a 0
FIXTURES N0. FEE MAIN DRAIN
Nater Heaters a-Cj Size IMaterial
Nater Closets To I Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
-avatories To Fee
(itchen Sinks WATER SYSTEM
)'sh Washer Size Material
Vaste Disposals Water Fixture Fee
Vash Trays HOUSE GASP IPING
Vashinq Machines No. Lines Outlets
Vater Treat. Equip. Size Fee
Sinks FEES
)ental Units Fixture Fees (7-0
)rinking Fountains Main Drain Fees
=1oor Drains Storm Drain Fees
Hoppers Water S s. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee ®O
Nater Leaders TOTAL FEE U
frailer Space INSPECTOR'S REPORT
iwim Pool Gas Pi in
ndirect Wastes Approved
)r well B
lackflow Preventer Partial
urvey Approved
B
Rough
TOTAL 0D Approved
B
Finish
Approved
B ' '