92051 (2) 1124 Milky Way
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date--------- -------- $ ,7------- 19..71.. Permit No.---- (G>l
The undersigned h eb c to I actor of }he Ci} of San Jose
for a permit ioginstall m i uta nd i e isted on the reverse side. y
Exemption from requirem nt for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑a
Undersigned attests that his State of Cit ontr c o : manse- D1�9
is in full force and effect and properly authorizes Phis ap lice tion.
San Jose City Business License #' �/-O/b /
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 violate the workmen's compensation laws of California.
OWNER RC86 L
ADDRESS 1/Z S f7I u a Lot No.
USE OF BUILDING"Zi14 aa!,. p o
2e0-30 Signed%icL e"09-q--, r.:.0-F.-
1124 Milky- Way Ace Plumbing
FIXTURES FIXTURES MAIN DRAIN,
Wafer Heaters Floor Drains Size Material
Wafer Closets 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 Size Material
Waste Disposals Swim Pool FEES
Wash Trays�;r' Indirect Wastes Fixture Fee
Washing Machines Drywell in Drain Fee
Wafer Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units _ Gas Piping Fee
Drinking Fountains Survey
Permit Fee 1 dQ
TOTAL TOTAL FEE j,pp
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines
Outlets Size
Rough Tested and Approved
F�msh By