HomeMy WebLinkAbout0042667-Plumbing (lateral)
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
VO/
N!! 42667
OWNER
DESIGNER ~ ~
USE/NATURE OF WORK---L1/ ~ J) -~ --'() ~ r - -;
BUILDING CONTRACTOR
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Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
?'
HEATING CONTRACTOR
Heat D AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type
Volts_ Amps_
Circuits
Fixtures
Switches
Receptacles
PLUMBING CONTRACTOR
/
f. C(~
_BT
_WH
_Sh
_FDr
_ L Tub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
-1 San. Sewer
-.l Storm Sewer
-L Water
VfUL
o (JJ <-
/G~
C-
_Lav
_WC
_Ur
_Sink
_ Eject
_SS
Other
FEES: Valuation $
ISSUED BY
/ CJ(!:J 0 ""
.S- . .J U Permit Fee Paid $
~ Date
i
I
30_00'/
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/ /
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE M d ~ AG<>rr_"
DATE
ADDRESS
TELEPHONE #
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Bachcub
LavlLca
ToileC
Kic.. Sink
Sink(other
Vi te heater
ADDIESS d7 ~ 'f (; - V
OWNER'-c~
NA~
sAN ~
wATER
SPE CTI ON
RELAY
DAn:
INSPECTION
DAtE
S/ltJ/sr S
loj17/J'Y
*'it Violation naces on the reverse side{
Floor Drain
Laundry Tu
Dis osal
Dishwasher
PEBHIT# }/'.2c,&; 7
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