11565898 Hyde Avenue — /
Building Permit Confirmed ly
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR P UMBING and/or GAS PIPING PERMIT
Date----------------- ------------------- No.-------- � 5�............
Tho undersigned hereby s pli f Ill (I I p r f the City of San Jose
for a permit }o install plum ng r en r I' fd y{e se side.
Erainpfion from require o to of aif.rnia or onfracfory License is hereby claimed
by undersigned: as no ❑ statement file ❑
Undersigned attests that his State of Califo ie recto statement
is in full force and effect and properly aufhorix i lic io .
San Jose City Business License� Sim
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
ADDRESS
USE OF BUILDING
28D.30 Signed
Lot No.
POR HVI9p Airomip.. a-Dachre.i600ls
Water Heaters
Size
IMaterial
Water Closets
To
I Fee
Bath Tubs
RAIN WATER DRAINAGE
Showers
Size
Material
Lavatories
To
Fee
Kitchen Sinks
Storm Drain Fees
WATER SYSTEM
Dish Washer
Size
Material
Naste Disposals
IWater Fixture Fee 11
Nash Trays
HOU PIPING
Vashing Machines
No.i Outlets
Yater Treat. Equip.
Size Fee
Sinks
FEES
Dental Units
Fixture Fees
Drinking Fountains
Main Drain Fees
Floor Drains
Storm Drain Fees
Hoppers
Water S s. Fee
Sand Traps
Gas Piping Fee
Urinals
Surve
Areo Drains
Permit Fee
Water Leaders
TOTAL FEE
frailer Space
INSPECTOR'S REPORT
iwim Pool
Gas Pip in
ndirect Wastes
Approved/O— 7--7
>ac Ktiow rreventerl / I I Partial
Finis)