67072 1.U99 Mi11cy Way G
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR P M ING and/or GAS PIPING PERMIT
ee : -441 e-RGliCV-
Date .�a - G '_(�..G......19...... Permit No./._ .ZO�Z...........................
The undersigned Is i + rrl nspecter of the City of San Josa for a
permit to install pluming Iii res and or p p s II t d en • reverse side hereof, and agrees to install
said fixtures and/or pipes in accordance with
' the provisions of Article VIII, Chapter 2, of the San
Jose Municipal Code, and all other laws appstcgble thar ��
1 certify that in the performance of of the ork whit the permit I shall not employ any
person in any manner so as to violate the workman's compensation laws of California.
OWNER 1"- 2-
ADDRESS D a-
It
USE OF BUILDING �p �/f�
Form 280.30 Signed ........ .... y ^Of�G �/......... .
Robuck
1099 Milky Wa, ecce a
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor Drains Size Material
Water Closets Hoppers To 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 Trailer Space Size Material
Waste Disposals Swim Pool FES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee '
Sinks Survey Water Svs. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
,40-0 Permit Fee
TOTAL tZ e0 TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Finish _ _ By