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~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
04578
TYPE:
BLDG 0 HTG 0 ELEC 0 PLBG ~ SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
USE/NATURE OF WORK
/7 err Vr~ ~/~/ &.
~7 p,,~ ,,,
~/.~/;~///L- 41k~//~,/
PLAN NO.
ADDRESS
OWNER
DESIGNER
, 5"'"Cv./"C/v
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC 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
-;;/(/ ~
~'-- - ro:?.~
_Lav
_WH
_Sh
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_BT
_WC
_FDr
_ LTub
_Ur
t:/ t,
-f- San. Sewer 1 rV{-
_ Storm Sewer
/1.,
. . (" C4"rz~
I
_Sink
Other
_ Eject
_SS
--'- Water
FEES: Valuat;on~ ~ /
ISSUED BY .. V r.?o-/
.".
Permit Fee Paid $
Date
J
/Cd~ .;
-;~slY?
Park Dedication $
Final/O.P. Cz:>7.1-c,p/,.,- /<"'...//,f
(
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~~ ~L i?]f:-SS?,}c;'
AGENT/OWNER
7-/ y-- ?/
DATE
ADDRESS
TELEPHONE #
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PLUMBER
/7(rUA.-/C-/-
/(~,. /( cq..Kh
PERMIT If Oc(~/g-
NATUREOFWORK ~~
ADDRESS
OWNER
OUTSIDE
INTERIOR
If New Relay Repair if If
I San Sew 4"'1 Bath tub Catch B.
( vI ate r t "t Lavatory Grease T.
St. Sew Toilet Sump P.
"Inspection J Date: Sink Kit. Local Waste
l Sink (other) Site Drain
c/ <: .. Shower L a un dry
{a'l.rc;/ . . Floor drain Laundry tray
Disposal w. So f tne r
Dishwasher D. Fountain
**Violation notes on reverse side
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