66665 A62 Lily ,
Building Permit Confirmed ❑
Not Required
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PI/PI/NG PERMIT
Date--- / --- -------------- 196. Permit No. b v �C S
.......--------.. ..
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner E) siatemeni filed O
Undersigned attests that his State of California Contractor's License
is in full force and effect and properly -rues }bappliaa/pi
San Jose City Business License #,, t/ , /
1 certify that in the performance of the work for which this permit is issued I shall not employ
any person in an mer so s to violat the works compensation laws of California.
OWNER —
b �
ADDRESS e
USE OF BUILDING
FORM 290-30 (REV. 3/661 IOM Signed ............. - - - ...
862 Lily ServisoPt
FIXTURES FIXTURES MAIN DRAIN
Wafer Heaters Floor 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 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 Q
INSPECTOR'S REPORT HOUSE GAS PIPING
Partial No. lines Ouflefs Size
Rough Tested and Approved
Finish // nj .f /L�. �r�9 BY