20405 (2) 9U0 ttyut AVt
Building Permit Confirmed ❑
Not Required E;�
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Datemwc=+'1._x.1! I�(,�... Permit No.�_�.- ..Q-`�--------------
The undersigned hereby k p #io t e P Bing 1 or of fhe City of San Jose
for a permit to ins#all plur in f s*
es sf n e averse silo.
Exemption from.requi n o of o ali orna n fors License is hereby claimed
by undersigned: a owner ❑ statement filed
Undersigned attests that'his State California Contractor's License n /�����
is in full force and effect and properly u o s�tt is a �I��G
San Jose City Business License #'_ %S
I certify that in the performance of the work for which this permit is saued I shall not employ
any person in any manner so as toYola# the workmen's compensation laws of California.
OWNER )2772Z99
ADDRESS 9D/ dcid/ G4// Lot No.
USE OF BUILDING r 1�P—/4-)
Signed .... .. ... 1 �L
280-30 (9-73) /t 12"
Jam//>
onr HYnF AVF A(7 1�y
FIXTURES N0. FEE MAIN DRAIN
Water Heaters Size Material
Water Closets To Fee
Bath Tubs RAIN WATER DRAINAGE
Showers Size Material
Lavatories To Fee
Kitchen Sinks WATER SYSTEM
Diah Washer Size Material
Noste Disposals Water Fixture Fee
Nash Trays HOUSE GAS PIPING
Noshing Machines No. Lines Outlets
Nater Treat. Equip. SizeFee
Sinks FEES
Dental Units Fixture Fees
Drinking Fountains Main Drain Fees
Floor Drains - Storm Drain Fees
Hoppers Water Sys. Fee
Sand Traps Gas Piping Fee
Urinals Survey
Area Drains Permit Fee G�
Nater Leaders TOTAL FEE
Trailer Space INSPECTOR'S REPORT
Swim Pool Gas Piping
ndirect Wastes Approved
)r well B
3ackflow Preventer Partial
purvey Approved
B
Rough
TOTAL Approved
B
Finish
Approved
VI B