74209 1647 Prospect Rd
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.-----------------.....-.-.... I Permit No.-------- --- -
The undersigned here makes pplication to the Plumbing Inspector of the City of �ose
for a permit to install um r es '➢n }bg/�arse side.
Exemption from re . e at e r tr ora License is hereby claimed
by undersigned: s owner ❑ statement filed 0
} hi !ors'Undersigned attests the State of Cal if Contractor's License
is in full force and iand properly authorixa h ;Ceti �
San Jose City Business
s License # s�
I certify that in the performance of the workI for which this permit is issued shall not employ
any person in any manner so as to violate f workmen's compensation laws of California.
OWNER 5-- ! Z// - --/T/.
ADDRESS
USE OF BUILDING
FORM 280-30 IOM 3/67 Signed.. / - --------- ---- --------------------
7647
------ --7647 Prospect Rd Bohart
FIXTURES FIXTURES MAIN DRAIN
Water Heafers / Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
ShowersUrinals Size Material
Lavatories Area Drains To Curb To Main Sewer
it tchen 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
—211,17
Wafer Treat. Equip, Backflow Preventer Storm Drain Fee
Sinks Survey Water Sys. Fee �e—Q
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee .0
161 TOTAL TOTAL FEE
INSPECTOR'SPORT HOUSE GAS PIPING
Partial :.Z/-t O No. Lines Outlets oZ Size
Rough �r Tested and Approved
Finish i By
/✓�