72535 877 Lonna Lane
Building Permit Confirmed ❑
Not Required [Q/
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.. ..� ..02.��.. 19./Q. Permit No.-------------------- .............. ----
The
...... -
The undersigned hereby makes application to the Plumbing Ins of ity San Jose
for a permit to install plumbing fixtures and/or pipes listed e r e side.
Exemption from requiremen+ for State of Califor ' o rec or's is s s or b laimed
by undersigned: as owner ❑ stafa an f'
Undersigned ¢ts that his 5#ata o ornia ontractor's ice # c,? 7 90
is in full force a feet and prop of n s f appy atio .
San Jose Ci B iness Li me
I certify the in the pert mane of t e rk w ich is permit is issued I shall not employ,
any person in a y manner s s So i e orKaren's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING )
FORM 280-30 10M 1/68
Signed
877 Lona Lane Ace .
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 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 EFixtureFee �_6
Washing Machines Drywell ain FeeWafer Treat. Equip. Backflow Preventer rain FeeSinks Survey ys. FeeDental Units ing Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE 3.
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No.:Lines Outlets Size
Rough Tested and Approved
Finish/ f �—Ji y /(4 By