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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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Ng 42189
OWNER
DESIGNER ~ .~
USE/NATURE OF WORK ~ ~ t}~L r- </ J/
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Class of Const..
Height
Occupancy Permit
"".
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_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
KJd-
_Lav
_OW
_SP
_ WSoft
_OF
_ CBasin
-.L San. Sewer
-L Storm Sewer
-f- Water
t/"fvL
6 fve
Ie!--
~
_BT
_WH
_Sh
_FOr
_ L Tub
_Disp
_WC
_Ur
_Sink
Other
_ Eject
_SS
FEES: Valuation $ ~'<3 Cl
ISSUED BY . ~
Permit Fee Paid $
Date
.?c~o&/'
/'0// .,c/9}c
/ I
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 4JJ1( ~
AGENT/OWNER
ItJ-/1.-tj1-
DATE
ADDRESS
TELEPHONE #
ADDIESS .:2-
OWNED.
NA'!"OU
~
SAN sml
iJAn:D.
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ON
DA'l'!:
msncnON
IN'tZRIOR.
I
Baeheub
Lavaeo
Toilee
DAn: fie. Sink
Sink( other
W te heater
S!W!ST 5 /b/I3j9/
Floor Drain
Laundry Tu
Dis osal
Dishwasher
** Viola~ion no~e~ on the ~eve~se ~idel.
fLC;/
nmaTI CP/ $ 7
I
Sum Pu
Ejector
Water Softener
Drinkin Fountain