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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
21537
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
(''1 ~ aJ ~r~ tfU-':_fr
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
~~
Foundation
Class of Const:
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HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
I
II~
_BT
_WH
_Sh
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_ San. Sewer
wfr-
_Lav
_WC
_FOr
_Ur
_ Storm Sewer
_Sink
Other
_LTub
_ Eject
_SS
_ Water
FEES: Valuation $ ? S-r C 0
ISSUED BY tJ ~
(/
Permit Fee Paid $
Date
""D. oe c//
////~9i>
/ -
Park Dedication $
Final/O.P. J 1- IS - 'D
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
PLUMBING PERMIT APPLICATION
Nl~ESS /II( 6-~~ DATE ,"/-'(9' PERMIT j.~
ER ~~ ~_~ PLUMBER lid
.'!JRE OF WORK C7 ~/~r~O I~
NEW RELAY REPAIR INTERIOR
/l-/ 3-?-;7
f
SAN SEW ift 1t
WATER Bathtub Catch Basin
STORM SEW Lavatory Grease Trap
Toilet Sump Pl.lmp
INSPECTION DATE INSPECTION DATE Kit Sink Local Waste
oK /1 /sft~ Sink(other) Site Drain
Shower Laundry Stand p~pe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Founta~n
Wa,ter Heater Ejector
Urinals Future outlets
1** Violation notes on reverse sidel