1185289V- ,Xyde Ave./
/ Building Permit Confirmed [l'
Not Required Cl
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date -----`----------------.�W'T 19_7!uPermit No. ..1.1_Ml�------------------
The undersigned hereby p' o o P int) ns of the Of of San Jose
for a permit to install plum n ' a o es sie rev se side.
Exemption from require n} or a e o ali { r ontrac or s License is hereby claimed
by undersigned: as wner ❑ statement filed [I
Undersigned attests that his State of Cah is rector's
is in full force and effect and properly aufho_,ux p licafi
San Jose City Business License #
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mannS!,,�q es fo/.iola}e the workmen's compensation laws of California.
OWNER
206
V
ADDRESS / G
USE OF BUILDING
28030
Signed ....
M
Lot No.
TER
Material
Waste Disposals Water Fixture Fee'
W::,
Trays HOIIsAOPlpwr
No.
Water Treat. Equip.
Size Fee
Sinks
FEES
Dental Units
Fixture Fees
Drinkin Fountains
Main Drain Fees
Floor Drains
Storm Drain Fees
Hoppers
Water S s. Fee
Sand Traos
Gas Plat.,.. Fe..
Area Drains I I I Permit Fee �—
Swim PoolI Gas Pipin
Indirect Wastes I I Approved
Parti
sh