99550 (2) 1096 Milky Way
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING CCPER/\MIT
Date....----------------- — ---..... 197.2- Permit No....9....9.15.. 1J.. 6........
The undersigned hereb L makes application to the Plumbing Inspector of the y of Sen Jose
for a permit to install p ��,,,�r,�y//�J�-,,_r p' T ed h v sid (���'7�
Exemption from re ' a en r MR C/—(.> e r ntr icense n h Wry cl^J➢'"�"
by undersigned: as owner ❑ statement filed ❑`�3 ,7 rr O ry
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly authorixas this application.
San Jose City Business License # y -7 `
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any mennor so as to violate the workman's compensation laws of California.
OWNER VA °'V VLEC1 - V
ADDRESS / L M 1 LKy W Lot No.
USE OF BUILDING
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zeo.aoSigned ..��.cC! - -�?----- -----•----------------------...----...
1096 Milky Way ace
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters f IFloor 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
Washing Machines Drywell- Maim Drain Fee
Water Treat: Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee - ( d U
TOTAL TOTAL FEE -) '00
INSPECTOR'S REPORT HOUSE GAS PIPING
PaAial No. lines Outlets Size
Rough Tested and Approved
Finish By