74586 847 Lily Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------- '3-..----------------------- 19.10-.d5. Permif No.-----1-L.J5(�.6---------------
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed 0�7n yO�
Undersigned attests that his State of California Contractor's License J
is in full force and effect and properly authorizes this application. _/ /
San Jose City Business License # /D/� 3 4
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mpa r to as to vPolafee the workmen's compensation laws of California.
OWNER ''
ADDRESS
USE OF BUILDING ACF PI IIMBING SERVICE
396 Perrymount & Cirne:of Stone Ave.
,FORM 280-30 IoM 1/88 Signed-------------------Saw-Soso;-G5iifoinia9572j
847 Lily
Ace 97-8107
FIXTURES FIXTURES MAIN DRAIN
Water Heaters ( Floor Drains Size Material
Wafer Closets Hoppers To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material
Lavatories Area Drains To Curb I To Main Sewer
Kitchen Sinks Water Leaders - WATER SYSTEM
Dish Washers NTrailece Size Material
Waste DisposalsFEES
Wash Trays astes Fixt&LFEE
Washing MachinesMae
Wafer Treat. Equip. revenfer Stoee
Sinks Wae
Dental UnitsGase
Drinking FountainsSur
Per
AL FEE 3• od
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. lines Outlets Size
Rough Nested and Approved
Finish 8
y