72203 X547' Prosp2ot
Building Permit Confirmed 21,
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe-��'- '-� 7----------------- 19-------- Pernnif No........ z d- --------------
The undersigned herby makes ap lication to the Plumbing Inspector of the City of Sen Jose
for a permit to install p�u�j��Zpllls�a�KrVpipA jislf� on-As reverse side.
Exemption from requEremenf f,0 fa a of C-Slif�rnla ,for�Conf actor's License is hereby claimed
by undersigned: is owner ❑ statement filed ❑
Undersigned attests that his State of California Contractor's License #
is in full force and effect and properly authorizes }/i p�aation. Qn/���
San Jose City Business License # //,V(1
I certify that in the performance of the work for which'}his permit is issued 1 ;611 not employ
any person in any manner so az to violate the workmen's compensation laws of California.
OWNER
ADDRESS 7`5 � 7 �i� - f-c-+�� xl
USE OF BUILDING
FORM 260-30 10M 3/67 Signed /-.�--_.--r-..1 .,�� --------------------------------
I
7597 Paospect Bohart
FIXTURES FIXTUPES MAIN DRAIN
Wafer Hearers / Floor Drains Size Material
Wafer Closets 9 Hoppers To � / To Septic Tank
Bath Tubs i Sand Traps RAIN WATER DRAINAGE
Showers I• Urinals Size Material
Lavafories .� Area Drains To Curb To Main Sewer
Kitchen Sinks / Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size " Material p
-Waste Disposals Swim Pool FEES /
Wash Trays Indirect Wastes Fixture Fee o0
Washing Machines / Drywell Main Drain Fee o�
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee / o
Dental Unifs Gas Piping Fee
Drinking Fountains Survey -
Permit Fee
TOTAL TOTAL FEE
IN REPORT HOUSE GAS PIPING
Partial 17— `/ �/i' No. Lines Outlets Size/
Rough Tested and Approved
Finish ` / By