69400 (2) 7967 Follistone
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING hand/or GAS PIP/INpG �PERMIT
Date--------dU&7-----�96 �/Re"raKit No.-----------4R---l.....l...v 0.--------
The undersignedhereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and y pipe's list j K r r a
Exemption from requirement for State ,o_f/ e�fyfiia F�, .WXc o �Ci nse is hereby claimed
by undersigned: as owner a statement filed ❑ /�/
Undersigned attests that his State of California Contractor's License # l z /oa
is in full force and effect and properly authorizes this ap I' afion.
San Jose City Business License
I certify that in the performance of the work for w ich this permit is issued I shall not employ
any person in any man so eyfo iolate the workmen's compensation laws of California.
OWNER_ /1=-- Oi• 3 C111i�e.
ADDRESS '?
USE OF BUILDING
FORM 200-30 (REV. 3/Gel IOM Signed. .`-- ..--- A` /
7967 Folkstone F&W
FIXTURES FIXTURES MAIN DRAIN
Water Heaters / Floor Drains Size /' Material
Water Closets 3 Hoppers To I To Septic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size / Material
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size / " Material
Waste Disposals Swim Pool FEES
Wash Trays f Indirect Wastes Fixture Fee /3�p
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee _ �0
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE „rp
INSPECTOR'S REPORT HOUSE GAS PIPI G
Partial /y /G� _ '�/L ��( No. Lines Outlets .2r Size 3/
Rough Testedand Approved �71'/G�
Finish / S” .�i 7 ��,:iw, —� By
/3 w 4-/� //