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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
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37110
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG yt(SIGN 0 ZONING - FLOOD PLAIN- HEIGHT-
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BUILDING CONTRACTOR
Size
Sq. Ft
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Canst
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0' Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type- Volts- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
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_WC
_FDr
-I. Tub
_SP
_Ur
- CBasin
--L San. Sewer
- Storm Sewer
+- Water
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Çt?frJe
(/~
_tav
_WH
_Sh
_Disp
_DW
_WSoft
_DF
_BT
_Sink
Other
_Eject
_SS
FEES: Valuation $ ~,a Ò
ISSUED BY ~
Permit Fee Paid $
Date
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I I
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
I 2--2 -7?
DATE
ADDRESS
TELEPHONE # .
ADDRESS
OWNER
1tATtJ'aE
u"
!NSPECTION
DATE
INSPECTION
DATE
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- Violat:ion not:l!s on !:hI! nVl!rsl! sidl!J
t
Bathtub
Laval:O
Toill!l:
Kil:. Sink
Sink(other
W te heater'
Floor Drain
Laundry Tu
Dis osal
Dishwasher
~I
nmc:Tt 1";; II '0
,.
Sum Pu
Ej ector
Water Softener
Drinkin Fountain
Slo Sink
Grease Tra
Local Waste
Site Drain
Laundr Stand i e
Catch Basin