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~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
21294
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
~~~~E~~ - - - - - - -/-6-;/ ;,J;)- ~;]5 ~~ - - - - - - - - - - - - - ~~~ ~~- - - - - - - - - - -
OWNER 6- JJ~ (-&
DESIGNER
USE/NATURE OF WORK
s~ ~"- - AJ~ g r-
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
!
Heat D AlC 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
_BT
_WH
_Sh
~~
' _Disp _ oft
_ CBasin
e,;J~
PLUMBING CONTRACTOR
_Sink
Other
_FDr
_ L Tub
_DW
_SP
_DF
_ San. Sewer
/ ~ ' 'AJ c....
----1- Storm Sewer r r'
_Lav
_WC
_Ur
_ Eject
_SS
_ Water
FEES: Valuation $
ISSUED BY
g.o ()~ 00
CJ~
Permit Fee Paid $
Date
I
'../
.t:O _ 0 0 ,y
C'D/..z 9/ 90
/ .-
Park Dedication $
Final/O.P. ! 6.-/9 '- 1:0
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~ ~~
U . 'G'"no,,,,, -b -
IcJ-.:zP-?o
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
-J.
NATURE
PLUMBING PERMIT APPLICATION
/67r.. U)J_cu~ ~ DATE . uy~~/.p~ ,
G-c4r - ~ ...-u. PLUMBER~
(/
OF HORK t""t;..~ s;.. ~~
NEW RELAY REPAIR INTERIOR
PE RMI T1f P / .;2 '7 jC
r!a-nJ9 ,
SAN SEW if 1,h
WATER Bathtub Catch Basin
STORM SEW ~';j'LJC Lavatory Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
off /r7/?i!/' Sink(other) Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain "i
Water Heater Ejector
Urinals Future outlets
1** Violation notes on the reverse side!