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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
23842
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ADDRESS
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PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
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
_BT ~WH
_Lav
_Sh
_Disp
_OW
_SP
_ WSoft
_ CBasin
&0~
_OF
_ San. Sewer
_WC
_FOr
_LTub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $ z. ~ . eo ~ Permit Fee Paid $
ISSUED BY W ~ Date
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Park Dedication $
Final/O.P. fa - J 7 -7/
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
DATE
ADDRESS
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TELEPHONE #
ADDRESS
OWNER
NATURE OF
PLUMBING PERMIT APPLICATION
DATE &" - / .3 - '7 /
PLUMBER
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PERMIT 1! ;2 J 1? Y2-
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SAN SEW 1! if
WATER Bathtub Catch Basin
STORM SEW Lavatorv Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPECtIoN DATE Kit Sink Local Waste
!~J /1 (.-/7 Sink(other) Site Drain
Shower Laundry Stand pl.pe
Floor Drain Laundry Tray
Disposal Wat.' Softner
Dishwasher D. Fountal.n
I Wa,terHeater Ejector
Urinals Future outlets
NEW
RELAY
REPAIR
INTERIOR
1**. Violation notes on reverse sideJ