NO PERMIT NUMBER (2) 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 Wafer Leaders WATER SYSTEM
Dish Washers Trailer Space Size I Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main 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
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. Lines Outlets Slze
Rough Tested and Approved
Finish By
1147 ;Kentwood Ave.
r ".Building Permit Confirmed'❑.
Not Required ❑
CITY OF SAN JOSE / BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date—.. .---. .� - - -------- 19-42?- Permit No...
The undersig d hereby me
kes li a ' Plu g s r of the City of San Jose
fora permit to install plumbing x} s d r erre side.
Exemption from requirement r !at of a ifornia or Cantrac r'z License*is hereby claimed
by undersigned: as own r statement filed ❑
Undersigned attests that his State of Califo onfractor's License #
is in full force end effectBusiness
and properly au}horiz pylic 7fjoQQ/t /�
San Jose an Business License #'_ !!!��/ / o
I certify that in the performance of the work for which this permit is iss ed I shall not employ
any person in any manner so as to violate the workmen's co ens i n laws of California.
OWNER
ADDRESS
tzz
USE OF BUILDING—42 _
20 0-30 so-ee Signed...._ .
1147 Kentwood Ave. S. Rafter