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~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
22725
TYPE: BLDG D HTG D ELEC D PLBG I(' SIGN D ZONING FLOOD PLAIN HEIGHT
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DESIGNER
USE/NATUREOFWORK F~~~ t; I~..d .2/ty/
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Cons~.
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
~~--
_WC _FOr
- Sink ~ ,1_';;TUb _
Other /- ~~ ~ .
I
_Ur
_CBasin
_ San. Sewer
_ Storm Sewer
w/-
_BT
_WH
_Sh
_Disp
_OW
_SP
_ WSoft
_OF
_Lav
_Ejec~ +- __SS~/ 4-_Water
3'-~~~
FEES: Valuation $ 179 g. C C Permit Fee Paid $
ISSUED BY ~ ~ Date
:;2-l!:>...L:; 0
-z./ ~ :2.,/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
~~.
\
~~GENDOWNER
;; _""1-2,..~ I
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNE R
NATURE OF WORK
NEW
;:;..;:2 7 ..;2.:5'
~ ah~. ?t.
SAN SEW ifF ifF
WATER Bathtub Gatch Basin
STORM SEW Lavatory Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPE CTI ON DATE Kit. Sink Local Waste
Sink(other) / Site Drain ~ J '" /..L
.
Shower Laundry Stand Pip~
Floor Drain / Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
TTrinals -g Future outlets
RELAY
REPAIR
INTERIOR
** Violation notes on the reverse side