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~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
22046
TYPE: BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
17~2._tlU4'1h-0 d4 _ iJ
c:-;. I f{:1^ is tAA ~-<a
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK '- ~--c..~...o..- L-</~-?A -'" a~ e,./ .s ~--t""'--
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
~&:'>
/SrI') r.l..fru #0
,
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF -J San. Sewer -'l II PvL-
_WC _FOr _SP _Ur -I- Storm Sewer .4jh 4/-c
_Sink _ L Tub _ Eject _SS -I-- Water .I 1/ {o-w~----
Other
FEES: Valuation $1 :?67m ~
ISSUED BY fi..6--- ""7/~
I
Permit Fee Paid $ :::?~l
Date--/- /c/-~
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 oL
@4AJlr, ~--
. AGENT/a' NER
cJg:/ '7
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNE R
NATURE
~ PLUMBING PERMIT APPLICATION
11 $Z,) R~~rvb~ b- --&---.- 0 ~ DATE / J / YC/:? /,
c C- -:zf _ ~yUMBER" ~,-e4
OF WORK ;()~ 6' ~ 1;Z~
rJ
. NEW RELAY REPAIR INTERIOR
PE~/ () )-Cf,
8fi.~ ~1
SAN SEW '-/-" fJ C iF iF
WATER I Cc.....- Bathtub Catch Basin
STORM SEW V Pv C. Lavatory Grease Trap
Toilet Sumo Pump
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
~/t<.J /5r5/ ,;2-//19/ Sink(other) Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
/ / Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
T1rinals Future outlets
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t** Violation notes on the reverse sidet