79917 1272 Primrose Way
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
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Date--. s.-Cl?-----L`3-- 19/_�l`P�e/rmyit No.------
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The undersigned hereby makes jp��if�an to�hejl't�mb'i g�nse Z e the City of San Jose
for a permit to install plumbing fieturas'k, dl/orTpi'pes 7lsfed ilia Treverse side.
Exemption from requirement for State of California for Contractor's.License is hereby claimed
by undersigned: as owner ((ll ste��ff�m. an} fila
Undersigned attests that his State of c❑aliforniaiO 'ac}or'sc a.� '
is in full force and effect and properly authorizes flis epplicationn.�I
San Jose City Business License # ,�/5,--
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 /a 7a
USE OF BUILDING
200-30 10.60 Signed Z ..� ......
1272 Primrose Way Ace
FIXTURES FIXTURES MAIN DRAIN
Water 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 To Main Sewer
Kitchen Sinks Wafer Leaders WATER SYSTEM
Dish Washers Trni!er Space Size Fmaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect WastesFixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survel' Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE ,,. 6Le)
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines
OutletsSize
Rough - Tested and Approved
Finish By
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