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~
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N~
20969
TYPE: BLDG D HTG D ELEC D PLBG % SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
I? g-&- U,,) ~ g-"-,,,-
r~~
(/
USE/NATURE OF WORK s:~/ ~~ d--/.d-~ ~. ~~ s: F
PLAN NO.
ADDRESS
DESIGNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATIN<3 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
f( ~
_Ur
_ CBasin
-1 San. Sewer
-.L Storm Sewer
-L Water
0....J1c-
'fof .. P V c..
'Y"(( Jc
I I'd-
_WC
_FDr
_ L Tub
_DW
_SP
_ WSoft
_DF
_BT
_WH
_Sh
_Disp
_Lav
_Sink
Other
_ Eject
_SS
FEES: Valuation $ I' 6 0 , 6 Q
ISSUED BY c4 W4
Permit Fee Paid $
Date
/
~O.6 6/
/~//V9d
Park Dedication $
Final/O.P. C; - /;1<:; -10
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
/tJ-/J'- .96
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NATURE OF WORK
.:t
NEW
tf-'fv C
SAN SEW /'
WATEK /.. ~
TORM SEW y., PV(
iF
INSPECTION DATE INSPECTION
L~4~(9'c?0-~76)
DATE
Bathtub
Lavator
Toilet
Kit. Sink
Sink(other)
Shower
Floor Drain
Dis osal
Dishwasher
Water Heater
rinals
t** Violation notes on the reverse side)
c70 7&9'
,
Pipe