77420 873 Lily Pool
Building Permil Confirmad [3�
Nof Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPIN�G/ PERMIT
Date......._� .�. .�.�.... - --- .. 19.cr-�!/Permit No. - - ��`Y� -
Tha undersigned hereby makes applica#ion lo the Plumbing Inspec}or ai Ihe Ci}y of $an Jos¢
for a permi} to ins}all plumbing iixturez and/or pipes listad on fhe reverse sida.
Eramplion from roquiremenf for $fale of Californie {or Confrac}ar's Licenze is hereby claimed
by undersigned: as owner ❑ sta4ameni filed ❑ �.,+
Undersigned aifes}s ihef his Sfafe of California Confrac}or's Licensa $k�6�� � /
is in full forca and afiacf and properly au}horizes fhis applicafion/.// �7p
San Josc Cify Business License # 7/� 2 ( o
' I cerfify th'a}�in iha performance of the work For which }his parmi} is issu¢d I shell noi employ
- any person in 'eny'�mannar so es to �iola}e the workmen's compansa4ion laws of California.
OWNER S G /�7oh-»^oiJ
ADDRE55 _��� L�l� �vb� '
USE OF BUILDING ` �C �
�I FORM zeo-ao toM t/ee $igned ........_- ..�t>.s.-...-��-�-----
A��ox� ���
I 873 Lily Anthony�ools
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Maferial
Water Closets Hoppers To To Septic Tank
, Bath Tubs Sand Traps RAIN WATER DRAINAGE
'�Showers Urinals Size . Material �
Lavafories � Area Drains To Curb To Main Sewer
Kifchen Sinks . Water Leaders WATER SYSTEM
Dish Washers Trailer Spcce Size � Maferial
Waste Disposals Swim Pool FEES
Wash Trays Indirecl Wasfes Fixfure Fee � �_
Woshing Machines Drywell Main Drain Fee
Wafer Treat. Equip. Backflow Preventer / Sfo�m D�ain Fee
Sinks Survey Wafer Sys. Fee "
Denfoi Unifs Gas Piping Fee '
Drinking Founfoins Survey
Permif Fee Z =
70TAL TOTAL FEE ,, ��
INSPECTOR_,5 REPORT HOUSE GAS PIPING
Partial � .5 �,u
Ae/`-�� No. Lines uN Size �
Rough � - / r Tesfed and rove
Finish �' „ /fn� �� By .