934631081 Milky Way
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
7 yG3
Date-----"------------------------------------. 19.Permit No. ---------------- ------------------------
The undersigned hareb kis �qp }i the s ctor of the City of San Jose
for a permit to install plu at OF c reverse side.
Exemption from requirement_P,/°/r State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed ❑
Undersigned attests that his Spero of Cali g�`ontrq�r/ 3
is in
Undersigned
force and effect and properly authori rhif ap �ef{sfp/j�(/ vLL//
Sen Jose City Business License # "� ' / y
I certify that in the performance of the work for which this permit is issued I shell not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER ZfJ/N7t2, 60. G,
ADDRESS
/ U � / /'r / L HI t✓ + -/
Lot No.
USE OF BUILDINGIC"
290-30 Signed. r-Z...Oee.' --= `--''u.:�:�rf--- -- --------------------..
1081 Milkv Wav Ace Plumbinq
FIXTURES
FIXTURES
MAIN DRAIN '
Water,Heaters
/ Floor Drains
Size Material
Wafer Closets
Hoppers
To To Septic Tank
Bath Tubs
Sand Traps
RAINWATER DRAINAGE
Showers
Urinals
Size
Material '
Lavatories
Area Drains
To Curb
To Main Sewer
Kitchen Sinks
Wafer Leaders
_
WATER SYSTEM
!Dish Washers
Trailer Space
Size Finaterial
sposals -
Swim Pool
FEES
,ys
Indirect Wastes
Fixture Fee /'00
Machines
Drywell
Main Drain Fee
at. Equip.
Backflow Preventer
Storm Drain Fee
-
Survey
Water Sys. Fee
its
Am
Gas Piping Fee
Fountains
Survey
Permit Fee 2 . aOTOTAL
TOTAL FEE 3. 00INSPECTOR'S
REPORT
HOUSE GAS PIPING
No. Lines Outlets Size
Rough
/�
Tested and Approved