96794 892 Hyde
Building Permit Confirmed ❑
Not Required L7�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GA/S� PIPING PERMIT
Date-------------------- -.................... 19Permit No.... ... j
The undersigned he by m s p ;cation to the Plumbing Inspector of the City of San Jose
For a permit io instal p o/)Akbi sted on the reverse side.
Exemption from r } t of nia for Contractor's License is hereby claimed
b undersigned: es owner ❑ statement F;led ❑
y Undersigned attests that his Staff-of California Contractor's License #
is in full Force and effect and grope orizes f� §Pp�;c io/
San Jose City Business License � / -
I certify that in the performance of the ork for which this permit is issued I shall not employ
any person in any manner so as to yiolete the workmen's compensation laws of California.
OWNER .S- TC-"2 N F,
ADDRESS f9.2- f/yId (g, `I V Lot No.
USE OF BUILDING 12,L,
28030 Signed..e&e-P
1
AQ9 14%yAn Avonna Ace
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 ,d
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
iinks Survey Water Sys. Fee
)ental Units Gas Piping Fee
)rinking Fountains Survey
Permit FeeZ, o 1
TOTAL TOTAL FEE 3. 00
INSPECTOR'S REPORT HOUSE GAS PIPING
'art�al No. Lines Outlets Size
lough Tested and Approved
1? t /' By