5669 6683 Uohn Dr. (�
/ Building Permit Confirmed 0/
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR
^^ MECHANICALL PERMIT
Date......&77 ...' ...................... IW.X Permit No..✓..U.A7.�1..---- ---.. ----......_-
The undersigned hereby mass application to the Plumbing Inspecto of the City of San Jose
i
for a permit to install the meefianita pfk))I'�d� on }ha'reverse sido,
�'/ nJ3L!'/o ``
Exemption from requiremen4 for State of Califon)" fyri(:on rtrt actor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑-s ?
Undersigned attests that his State of Cal�( rn is Contractor's License t
is in full force and effect and proporly auihorrixes6his ap FRation /
San Jose City Business License
I certify that in the performance of the work for which is"issued l shall not employ
any person in any m rx so as t io to the workmen's compensation laws of California.
OWNER = / p
ADDRESS — GGA/ 3 Lot No.
USE OF BUILDING
Signed--(,l1 -- ------ --- N..14 ��. -.x
280-20 (9-73)
G7ifiys-+-�-•-�--.
99RX -T,,I v n— Ll..4,. A /f,/
Type of B.T.U. Remarks Check V)
Appliance No• Input New Replace Relocate
Gas Ranges
Wall Heaters
Boilers (Steam)
Boilers (Water)
Blower Furnaces
Suspended Units
Clothes Dryers
FEES
Appliance Fee T, o-O
MISC Flues/Vents Fee
Flue/Venf Hood/Ducts Fee
Hood/Duct Gas Piping Fee
Condensate Drain Cond. Drain
Permif Fee
�� _
TOTAL FEE • ri✓
INSPECTION RECORD
Ducts Underfloor
Ducts Complete
Flues in Wall
Flues Complete
Appliances/Misc.
No. Gas Lines Outlets Size
Tested and Approved