79590 847 Lily Ave
�I( Building Permit Confirmed ❑
Not Required ET--
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
i
Dafew/yfJ'////�.. ---------------- 194 Permit No-------0�5..3?-----------------
OTe 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
Undersigned attests that his State of California Contractor's License #'
is in full force and affect and properly athis ap��cat,
San Jose City Business License #-::-7, P
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 violate the workmen's compensation laws of California.
OWNER `/ a
ADDRESS
USE OF BUILDING 1///n
_ 360-30 ro-ea Signed "Y lI. U�=-�--
847 Lily Ave
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FIXTURES FIXTURES MAIN DRAIN
Water Heaters j Floor Drains Size Material
Water Closets Hoppers . To I To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers - Urinals _ SizeMaterial
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size rMaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee o
Washing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks P, _ r Survey Water Sys. Fee
Dental Units Gas Piping Fee. -
Drinking Fountains Survey
Permit Fee a a a
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish By
Al1Y' 3717 7t ! 7671