NO PERMIT NUMBER (2) i
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To I 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 1, 0o
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee .00
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee C-P,Ov
TOTAL TOTAL FEE 4500
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
RFiough Tested and Approved
nish O .�/�i>'v BY
1145 Kentwood
' Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING
and/or GAS PIPING PERMIT
Dafe.----d----- -�------- 19'Dd.. Permi# No.... 4v—,&
The undersigned hereby me s a pl' fi f ing ecfor of the City of San Jose
for a permit to install plumb' g i s pi I' t h reverse side.
Exemption from requiram t o ate o Ca ifo nia or Co actor's License is hereby claimed
by undersigned: as wner ❑ statement filed
Undersigned attests that his State of Cal'o ont 6 3 U
is in full force and affect and properly au�hf z i ' e
San Jose City Business License #_ '/ ' 7
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to viol the workmen's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING
FORM 280-30 10M 1/68 Signed....
11495Kentwood Szrvisoft