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77180 (2) 837 Lonna © Building Permit Confirmed ❑ / Not Required ❑ CITY OF SAN JOSE BUILDING DEPARTMENT APPLICATION F/`OR PLUMBING and/or GAS PIPING nPERMIT Date&pzlirstall . /.-....----------- IYFd Permit No...- F--� U--------------- Thned hereby makes application to the Plumbing Inspector of the City of San Jose fora plumbing fixtures and/or pipes listed on Ane reverse id e. _ Exemption from re i ant for Sfafe of California for Contractor'saimed-- by undersigned: as owner statemen dad Undersigned alta s t t his State o a i orr is e # �s is in full force and fact and properly author' this a pli at'... / San Jose City B siness Licens # I certify that in the perform nca t ork or hic thi a is issued I shall not employ any person in any annex so to v' late pensafion I s of California. OWNER �l ' ADDRESS USE OF BUILDING FORM 280-30 IOM t/ee Signed "...... 837 Lonna FIXTURES FIXTURES MAIN DRAIN Water 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 I To Main Sewer Kitchen Sinks Water Leaders WATER SYSTEM Dish Washers Trailer Space Size rMaterial 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 Water Sys. Fee Dental Units Gas Piping Fee ' Drinking Fountains Survey Permit Fee TOTAL — TOTAL FEE INSPECTOR'S REPORT HOUSE GA PIPING Partial No. Lines Outlets Size Rough Tested and Approved Finish//� —:j �a / ..��v✓� By