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69664 . y5y3 Pi�aspAb� Building Permit Confirmed 4�-- Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION FOR PLUMBING and/or GAS PIPINGG/ PERMIT Date....----- �..R.Q......................_. 1947 Permit No.-------------- The ---------The undersigned hereby makes application to the Plumbing 1�!jpactor of the City of San Jose fora permit to install plurrjbfn' f'i j �n'd 5 pi Med nolhe reverse side. 6emplion from requve�e%, 4a1e� Celifornia i�VICK cfor's License is hereby claimed by undersigned: asVownor ❑ statement filed- P/ Undersigned attests that his State of Californlg Contractor's License $}' Gj is in full force and effect and properly authorinesj is Opp ca , San Jose City Business License # �� tel" (j I certify that in the performance of the work for whit thi permit is issued I shall not employ any person in any ma a so as to v' late the workmen's compensation laws of California. OWNER — ADDRESS USE OF BUILDING igned ..`-Z&..----- - ------- '----- 'FORM 200-30 IREV. 3001 IOM � 7573 PrDSPPCt F&W FIXTURES FIXTURES MAIN DRAIN Water Heaters Floor Drains Size Materia Water Closets Hoppers To To Septic Tank Bath Tubs / Sand Traps RAIN WATER DRAINAGE Showers / Urinals Size 1, Material �y , Lavatories Area Drains To Curb To Main Sewer Kitchen Sinks / Water Leaders WATER SYSTEM Dish Washers Trailer Space Size Material 2 , Waste Disposals Swim Pool FEES Wash Trays / Indirect Wastes Fixture Fee •UO Washing Machines / Drywell Main Drain Fee Water Treat. Equip. Backflow Preventer Storm Drain Fee* Sinks Survey Water Sys. Fee o D Dental Units Gas Piping Fee O Drinking Fountains Survey Permit Fee u O TOTAL / TOTAL FEE . gyp INSPECTOR'S REPORT HOUSE GAS PIP NG Partial -e27_ ^,4 _ No. Lines Outlets Z Size / Rough Tested and Approved _?�/L.-7 Finish By O y J -^i�M v - -