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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
18168
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
.......-... ----..-.............. --........ --..............-.... --..... --.......................... --... --.... -- ---.. -- --....
ADDRESS ~/ J' J ;(}/f
OWNER ()~~r~~
DESIGNER ~.
USElNA TURE OF WORK Lo/ s<:<.- .r"'~ ~ ./2?,a.e /,,-psn /;1
PLAN NO.
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
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 ~y ~--
_BT _WH _Disp
_ WSoft
_ CBasin
_Lav
_Sh
_FOr
_ L Tub
_OW
_SP
_OF
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_Sink
_ Eject
_SS
_ Water
Other
. dV
FEES: Valuation ~
ISSUED BY ~~/~.
/
/ t:n" /
Permit Fee Paid $ /0
Date ..e;/-,z(' "-~d
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 (JL. Z ~~;
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
NA'IURE
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PLUMBtNG PERMIT APPLICATION
.~ DATI! J ~
~ ~1::Ea ',,-
PER..'!IT{; . Iffl (8
OF WORK
NE'{y
(~y
REPAIR
INTERIOR
SAN SEW 1F 1F
WATER Bath tub eatch Basin
~,.nJ:lM.::m Lavatory , Grease Trap
Toilet I SumDPum'O
INSPECTION DATE INSPECTION DATE Kit. Sink Loc al Wast e
6~~/ &i/~ Sink(other) Site Drain
~/1/~ Shower Laundry Stand P1.pe
z':"'l-C r \ Floor Dr:ll.in . I Laundry Tray
Disposall Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
TT,..;nal s Future outlets
1** Vi.olation not~s on the reverse sidel