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~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
23240
TYPE: BLDG D HTG D ELEC D PLBG r)f SIGN D ZONING FLOOD PLAIN HEIGHT
::N::~ - - - - - if;- - ~~5 - - - - - - - - - - - - - - ~L~~ ~~- - - - - - - - - - -
V /;
DESIGNER
USE/NATURE OF WORK
A/.,Q~ .s t= I?. -
.
6~~ 4/7
(/
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Con st..
Height
Occupancy Permit
Foundation
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
PLUMBING CONTRACTOR
~d~~
c
_WC
_Ur
_ CBasin
~ San. Sewer
-L Storm Sewer
-I- Water
4J/C-
~ (JUG
~~VL
I~
_Sink
Other
_FOr
_LTub
_Disp
_OW
_SP
_ WSoft
_OF
_BT
_WH
_Sh
_Lav
_ Eject
_SS
FEES: Valuation $ C.sG;l, c 0 Permit Fee Paid $
ISSUED BY vJ ~ Date
If'
:2 0, ~ 0
r~/-9/
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 ~ ~..
/1 AGENT/OWNER
ADDRESS C/
5-1/9;
DATE
TELEPHONE #
SAN SEW yfJ{ 4ft 4ft
WATER J~ Bathtub Gatch Basin
~TORM SEW <-r-Pv C Lavatorv Grease Trap
Toile t Sump Pump
INSPECTION DATE INSPE CTI ON DATE Kit. Sink Local Waste
~o~.,L Sink(other) .Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
- 'i:Y; I Disposal Wat. Softner
~ w<-. . j~ Dishwasher D. Fountain
Water Heater Ejector
TTrinals Future outlets
ADDRESS ~
OWNER ~
NATuRE OF(lWORK
NEW
~
a
rt7;t.
~PLmmING ,PERMIT ~PL~~,tTION
.6-~ DATE -5 /?
~ '-~9' .
. ~ ~F . r-t) .-J~~,
RELAY
REPAIR
INTERIOR
f** Violation notes on the reverse sidet