NO PERMIT NUMBER (7)i
FIXTURES
FIXTURES
MAIN DRAIN
Water Heaters
Floor Drains "'
Size Material
Water Closets
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
Indirect Wastes
Fixture Fee 1,0o
Washing Machines
Drywell
Main Drain Fee
Water Treat. Equip.
Backflow Preventer
Storm Drain Fee
Sinks
Survey
Water Sys. Fee .00
Dental Units
Gas Piping Fee
Drinking Fountains
Survey
Permit Fee p7,Ov
TOTAL
TOTAL FEE 4500
INSPECTOR'S
REPORT
HOUSE GAS PIPING
Partial
No. Lines Outlets Size
RFiough
Tested and Approved
nish '' O
.;/�i>'v
BY
1145 Kentwood
' Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING
and/or GAS PIPING PERMIT
Dafe.----d----- -�------- 19'Dd.. Permi# No. ... 4v— &
The undersigned hereby me s a pl'fi f ing ecfor of the City of San Jose
for a permit to install plumb' g i s pi I' t h reverse side.
Exemption from requiram t o ate o Ca.fo nia or Co actor's License is hereby claimed
by undersigned: as wner ❑ statement filed
Undersigned attests that his State of Cal' o ont 6 3 U
p
is in full force and affect and roperly
San Jose City Business License #_ '/' 7
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violthe workmen's compensation laws of California.
OWNER ('�'/t �(/ 5 Pn
ADDRESS
USE OF BUILDING
FORM 280-30 10M 1/68 Signed ....
11495Kentwood Szrvisoit