73119 1819 Lilac Ct.
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe ' /-------------- 19(/. .. Permit No--------------
The undersigned hereb makes a lic do to th bin I ctor of the City of San Jose
fora permit to install p i reverse side.
Exemption from req ' o or is for Con rector's License is hereby claimed
c/l�aimeyd '
by undersigned: as owner ❑ •.s Livenfiled
Undersigned attests fhe+ his State�Cali{gnie Co tractor's Licenss e
is in full force and effect and properlyhues thi t' i
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 manner as to Violate the or a compensat' laws of California.
OWNER
ADDRESS 2r
USE OF BUILDING
FORM 280.30 IOM 3/67 Signed ..--------
7819 Lilac Pierce
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Wafer Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Cur I To Main Sewer
Kitchen Sinks Wafer Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPI G
Partial
Rough No. Lines Outlet Size
Tested and Approved
Finish � By