74998 1127 Kentwood
.q Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date-----------T...�------- - ------- 19(-ePermit No..---7..r...�? ... .
The undersigned here�rye }]k(}�/Nglt�tor a the City of San Jose
for a permit }o install p r s o as �Js�reverse side.
Exemption from req uuemenf or Sfefe of Cali orn is for Contractor's License is hereby claimed
by undersigned: as own � - p} J
Undersigned attests that his State li a Co o i n
is in full force end effect and properly or his p WIC
San Jose City Business License $ �r'� — �O V-3/1
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 4911<E (tUv�JSTi972,
ADDRESS / / 7 ,\ E�TL(JDD/� �yEJ
USE OF BUILDING '-R>e-'� ACE PLUMBING 4EPVICE
396 Perrymount Br Corner of Stone Ave.
FORM 2e0-30 rOm 1/6a Signed -------- SATT 1oso;-£a1ifornizr-4514+r---------------
297-8107
1127 Kentwood Ace
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters / Floor Drains Size Material
Water 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 Indirect Wastes Fixture Fee
Washing Machines Drywell Main 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
TOTAL jQD TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Size
Rough Tested and Approved
Y