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35760
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
OWNER
DESIGNER
Als.c" - ~ fIJJ
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
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HEATING CONTRACTOR
Heat 0 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
~T -L WH
~Lav _Sh
.3 WC ~FDr
LSink _LTub
Other
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-L Disp
-LDW
L-sp
_ WSoft
_DF
_ CBasin
_ San. Sewer
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_ Storm Sewer
_ Eject
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_SS
_ Water
FEES: Valuation $ S"/ ?R', 'Q 0
ISSUED BY ~
Park Dedication $
Final/O.P. la/:2&/'13-
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR4~-A.. ~ -
\ AGENT/OWNER
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ADDRESS
TELEPHONE #
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PLtJMBING PE1OO:-r APPLICATION . .. .
ADDIlESS /(,7'/ ~~J~ u.m: :;//~/:'3. PDIlITI SS7{,O
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NATOU OF "em:: A/.-f ~ ~ - ~ ....,.,
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NEt~ REI.AY BEP AIR INTERIOR
SAN SEW # #
wATER .;l Bathtub " / Sump Purno I
"'___u sm 3 LavatD1:"V' ( , Ejector
~ Toilet I I I Water Softener
fNSPEcnON 'DATE tNsnCTIOH DAt! / Kit. Sink i Drinkin ~ Fountain
4G- ~/Yh 00 Sink(otber) n. ;n","
,., S-'llg - I W"'terheater t Slop Sink
Grease Trap
f 10/2-,/73 I Floor Drain I Local Waste
Laundry Tub I Site Drain
/ Disposal I I Laundry Standpipe T ,
I Dishwasher I Catch Basin
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