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HomeMy WebLinkAboutPlumbing (laterals) CITY OF �SHKOSH N4 17806 n PERMIT - APPLICkTION AND RECORD TVPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING _ FLOOD PLAIN _ _ HEIGHT ' _ " " " " " " _ _ " _ " " ' _ _ " " _ " ' _ " _ _ " " " " ' _ _ " " ' _ _ " _ " " _ " ' ADDRESS � �i'/�/s ���L.s�^rw � PLAN NO. OWNER �� {py[ /�/vLif _._ I DESIGNER USE'NATURE OF WORK P-r^/ d �^rft'V�= BUILDING CONTRACTOF — Size Sq. Ft. # Fooms # Stofies Height Foundation . Class o� Const Occupancy Permi� HEATING CONTRACTOR Heat ❑ AiC ❑ Vent ❑ Fuel'System Heat Loss — BTU'S ELECTRIC CONTRACTOR Elec�ric Serv. New ❑ Chanqe ❑ Temp ❑ Type—_ Vol[s Amps FizWres Swi�ches Receptacles Cirwits PLUMBING CONTRACTOR . . _ . BT WH Disp —`NSoft CBasin "� y ��iiG Lav —Sh —�W DF �San. Sewer� WC FDr SP Ur _. _Storm Sewer —_Sink LTub —.Eect SS �Water�/`fT�i�f� Other <Y• �r FEES' Valuatio�n $//'� v Permit Fee Paid $� Park Dedication $ ISSUED BV � 4��/.Ti� Da�e ��--�� Flnal/O.P. In ihe peAormance of ihis work I agree ro pedorm all work pursuan� b rules governing ihe tlescribed constmc�ion. —� <� \ , � , 5a SIGNATUFE ��J � AGENT�OWNEP DRTE ADDRESS TELEPXONE Y PLIIMBING PERMIT APPLICATION ' �'�n �^�„� , ^r �.. f l�r ;,nx� `%' i�; rExru li ! 7.��,� ADDRESS " � �/ � � OWNEA "�' ' f� ";' PLUPffiER � / NATORE OF WORK �W RELAY REPAIR INTEAIOR k SAN SEW `�' �� WATER a[htub Gatch Basin STORM SEW avaeo Grease Tra Toilet S�mp Pum NSP CTION DATE INSPECTION DATE Ki[ Sink Local Was[e Sink(other) Site Drain ����� � ; � . _ Shower Laondry [an pipe p hJ � ° '�/ � � �"` Floor Drain Laundry Tcay �,�� �.�_ �' �1G`����/�L Disposal WaL So tner Dishwasher D. Fountain Waeer Heater Ejector' Urinals F�Cure outle[s ** Viola[ion nores on reverse side