8899811U1 ivillKy way
Building Permit Confirmed ❑
Not Required 011—
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Dafe-------------- - ���-.._..-_.
..
The
undersigned hereby makes application to }he Plumbing 1 ecfor of the City of San Jose
for a permit to install plumbi x r / e i d reverse side.
Exemption from require e a r i r o actor's License is hereby claimed
by undersigned: as nor ❑ statement filed ❑.
Undersigned attests that his State of Calforni Con}rac}or's Licensee # 27>90�
i
is in full force and effect and properly author es
e licati � d
San Jose City Business License # a
i
I certify that in the performance of the work or which this permit s issue I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER 6Z n2
ADDRESS Il e>)- ZL7 lzl l WAx/ Lof No.
USE OF /BUILDING Ode S
260-60 Aug. 69 ( Signed .a-CP..� sim.��.�..Y.�-104--..------
1102 Milkv Wav Ace Plumbina
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
Washing Machines
Indirect Wastes
Drywell
Fixture Fee .�-
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 c�
TOTAL
TOTAL FEE 3 r�
INSPECTOR'S
REPORT
HOUSE GAS PIPING
Partial
Rough
No. Lines Outlets � Size
Tested and Approved