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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
O~294
~~P_E~ _ _ B_L~~ ~ _ ~T~ _ ~ _ ~~E~ _ ~ _ ~~B~ ~_ ~I~~ _~ _ ~O_N~N~ _ _ _ _ _ _ _F~~~D_ ~L~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _
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ADDRESS
PLAN NO.
OWNER
DESIGNER
e~Sf' d7~/p( ~4L~
USE/NATURE OF WORK
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 ~ S' 71~j~
-I- BT -L WH - Disp _\vSOft
-I- Lav ----'- Sh - OW - OF
--I-- WC -I- FOr -I- SP - Ur
-+ Sink -I- L Ti:l'& - Eject - SS
Other
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
~- ~2ud
FEES: Valuation $. Permit Fee paid. $ .
ISSUED BY ~ Date /) -;; rr;ft
Park Dedication $
Final/O.P. 1-;Z:5 -~ 8'
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /- ~
~
AGENT/OWNER
n. //. ;#. ~ g- $"C)
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NATURE OF
~Rjr Zfi/UMBn;::'ERM:::PLI/C;!~O;;p . . PERMIT #
f . ~ --1 PLUMBER ~S ~~/J/1/I'\ ~M_\
WORK ~ -C...-/ S 1C-
('JC~1<(
SAN SEW 4F 4F
l Bathtub I Catch Basin .
WATER
STORM SEW I Lavatorv , Grease Trap
'I Toilet , 1 Sump Pump 1
INSPECTION DATE INSPECTION DATE ' J Kit Sink I Local Waste
ut..-J<[ [( /r'5M Sink(other) Site Drain
Shower I Laundry Stand p1.pe I
7 Floor Drain I Laundry Tray I
Disposal I Wat. Softner
/~ Dishwasher , D. Founta1.n
T Wa.ter Rea ter i Ejector
- Urinals Future outlets
NEW
RELAY
REPAIR
INTERIOR
f I !Ps{&9
on reverse side