69664 (2) . y5y3 Pi�aspAb�
Building Permit Confirmed 4�--
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPINGG/ PERMIT
Date....----- �..R.Q......................_. 1947 Permit No.--------------
The
---------The undersigned hereby makes application to the Plumbing 1�!jpactor of the City of San Jose
fora permit to install plurrjbfn' f'i j �n'd 5 pi Med nolhe reverse side.
6emplion from requve�e%, 4a1e� Celifornia i�VICK cfor's License is hereby claimed
by undersigned: asVownor ❑ statement filed- P/
Undersigned attests that his State of Californlg Contractor's License $}' Gj
is in full force and effect and properly authorinesj is Opp ca ,
San Jose City Business License # �� tel" (j
I certify that in the performance of the work for whit thi permit is issued I shall not employ
any person in any ma a so as to v' late the workmen's compensation laws of California.
OWNER —
ADDRESS
USE OF BUILDING
igned ..`-Z&..----- - ------- '-----
'FORM 200-30 IREV. 3001 IOM �
7573 PrDSPPCt F&W
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Materia
Water Closets Hoppers To To Septic Tank
Bath Tubs / Sand Traps RAIN WATER DRAINAGE
Showers / Urinals Size 1, Material �y ,
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinks / Water Leaders WATER SYSTEM
Dish Washers Trailer Space Size Material 2 ,
Waste Disposals Swim Pool FEES
Wash Trays / Indirect Wastes Fixture Fee •UO
Washing Machines / Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee*
Sinks Survey Water Sys. Fee o D
Dental Units Gas Piping Fee O
Drinking Fountains Survey
Permit Fee u O
TOTAL / TOTAL FEE . gyp
INSPECTOR'S REPORT HOUSE GAS PIP NG
Partial -e27_ ^,4 _ No. Lines Outlets Z Size /
Rough Tested and Approved _?�/L.-7
Finish By O y
J -^i�M
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