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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
06697
ADDRESS
TYPE: BLDG 0
FLOOD PLAIN
PLA NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
# Stories
Occup ncy Permit
Height
Sq. Ft.
# Rooms
Foundation
Class of Const.
HEATINQ. CONTRACTOR
Heat' 0 NC 0 Vent 0 Fuel/System
Heat Loss
~,
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type _ Volts _ Amps
Fixtures
Switches
Ci rcuits
Receptacles
PLUMBING CONTRACTOR
_BT
_ CBasin
--/ San. Sewe
-I- Storm Se er
-I- Water
_WH
_Sh
_Disp
_ WSoft
_OW
_SP
_OF
_Lav
_WC
_FOr
_Ur
_Sink
Other
_ L Tub
_ Eject
_SS
FEES: Valuation $ p ~
ISSUED BY /-7..-~ ~
#'
Penn it Fee Pa;d $ ~.. --6
Date ab.:z .
I
Park Dedi ation $
Final/O.P.
HEIGHT
TU'S
~{jt;7vc
ijt't PVC
. &r '
/
In the performance of this work I agree to perform all work pursuant to rules governing the described c nstruction.
SIGNATURE
.../
ADDRESS
DATE
TELEPHONE #
~"~....
PLUMBING PERMIT APPLICATIOk
~:ot!:r/J41 a ~(t5 ~7
ADDRESS DATE 11136 0/ PER} IT 1F
TL
OWNER PLUMBE~ ~ 'r vr/ ('
NATURE OF WORK 0~ LA/' ~ S.J--
NEW RELAY REPAIR INTERIOR
'4"PV( 1F .-
SAN SEW 1F
WATER (. I' e;{f1~ Bathtub Ca tch Bas in
STORM SEW '1"""V{/ Lavatory Gr ease Trap
Toile't Su np Pump
INSPECTION DATE INSPECTION DATE Kit Sink Lo al Waste
(6IJCY~/ w/o / ~'P ~ Sink(other) Si e Drain
Shower La ndry Stand pl.pe
Floor Drain La ndry Tray
Disposal Wa Softner
Dishwasher D, Fountal.n
W,a,ter Rea ter Ej ctor
Urinals Fu ure outlets
[** Violation notes on reverse sidel