69400 (2) 7985 F61&;st0i6
Building Permit Confirmed
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPPING PERMIT
Date._.AN7--------1967---------------------- 19........ Permit No.-------- '-"
The undersigned hereby makes a plication the P uT ng Inspector of the City of San Jose
for a permit to insta m er n aes . e on the reverse side.
ap. F
Exemption from r�dsre } for tate > alifornie or Contractor's License is hereby claimed
by undersigned: as o >L {orn //
Undersigned attests that his state
of, ie,Grf racfo�r sl•ric
is in full force and effect and properly ufhorixes this pl� � 7
San Jose City Business License
I certify that in the performance of the work for which AW permit is issued I shall not employ
any person in any ma er so as to vi, the,workman's compensation laws of California.
OWNER
ADDRESS
USE OF BUILDING161
...... `
60flM 29030 (REV. 91061 IOM Signed � �'� """""' "' ---------
7985
----`
7985 Folkstone F&
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters J Floor Drains Size-4/ " Material C
Water Closets 3 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 / Water Leaders WATER SYSTEM
Dish Washers Trailer Space Isize /fMaterial
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee 97
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee .0 p
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial L /.Z 167 - ,//- ,. No. Lines / Outlets Size /
Rough r/ L' ( Tested and Approved,
Finish C 7 // L•' ��.a.e� By