5003'1102 Milky Way
Building Permit Confirmed
Not Required ❑
CITY OF SAN' JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-------/�--- -----
19-----.. Permit No- ---------------- �.d............
The and reigned hereby akes application to the Plum hi Inspector of }he City of San Jose
for a permit +o install plu r r i / is
o fhe reverse side.
Exemption from requi t e o i i or on}ractor's License is hereby claimed
by undersigned: s owner ❑ statement filed ❑ ? �/?
Undersigned attests that his State of {�aals�LGwsnia Contractor's License # /��ot 7J
is in full force and effect and -properly auylgs(tes/i-l.,
San Jose City Business License # Y CC..// �l(—/ s 6 6
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
ADDRESS/OG/%�'C�j� !/�.�� Lot No.
"-USE OF BUILDING / G
I
28030 Signed.% ...................... .'-----........
_�Ct
1102 Milk.V WaT T & `Const.
FIXTURES
FIXTURES
MAIN DRAIN
Wafer Heaters
Fl oor 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
To Main Sewer
Kitchen Sinks
Wafer Leaders.
WATER. SYSTEM -
Dish Washers
Trailer Space
Six-e[ Material
Waste Disposals
Swim Pool
FEES
Wash Trays
Indirect Wastes
Fixture Fee
Washing Machines..
Drywell
Main Drain Fee
Wafer Treat. Equip.
Backflow Preventer
Storm Drain Fee
Sinks
Survey
Water Sys. Fee
Dental Units
Gas Piping Fee
Drinking Fountains
Survey -
Peimif
TOTAL
TOTAL FEE
INSPECTOR'S REP RT
Partial -?, - 3
e_....
HOUSE GAS PIPING
No. Lines 4=X70utlet s. / Sized C!