HomeMy WebLinkAbout0019072-Plumbing (laterals)
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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
19072
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .' - - - - - - - - - - - - - -
OWNER
:1:: ~:~::ise~
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
~(:A-
/2/[/{ cI ~~ h~ ~/
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
I
Foundation
Class of Const.
I
/~,
fiFATING 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
_BT
_WH
_Sh
J~~ ~&Qc--h~
_ Disp _ WSoft
PLUMBING CONTRACTOR
_WC
_FDr
_ L Tub
_DW
_SP
_DF
_ CBasin
-I- San. Sewer 4&'..r::'vc
-I- Storm Sewer '9'e,/y C-
.J- Water I // C:CP;o"P
_Lav
_Ur
_Sink
Other
_ Eject
_SS
FEES: Valuation $ eoz> Ol>
ISSUED BY ~V~~
<e t?1) /'
Permit Fee Paid $ U ()
Date 6- -..2 2... --"l' Cl
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 ~ y~~-
C AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NATURE
PLUMBING PERMIT APPLICATION
176r/~1f~r DATE t-'r;f6 PERMIyH_~r(j7~
OF:: ;;f~ ;;::f (k-~~ PL;~~' &,MJ::,j~-
NEW RELAY REPAIR INTERIOR
SAN SEW L./t.l if: if:
WATER I tI Bathtub Catch Basin
~TORM SEW ,I.... Lavatory Grease Trap
J Toilet Sump Pump
INSPECTION DATE INSPE CTI ON DATE Kit. Sink Local Waste
Sink(other) Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
TTrinals Future outlets
t** Violation notes on the reverse sider