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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
16611
TYPE:
BLDG D HTG D ELEC D PLBG g SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
IS'/,S- n?~/~
,() (lL //U C (
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK C0?7)'7<':r'.J~ /- F/4 SP-!.-,-/~ - ;:>HL~dl'
O'\/l~ rP~~)- ifl(O?J-y-
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
I'
Foundation
I
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
u~&k__
_BT
_WH
_Sh
-1 FDr
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_Lav
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_Sink _LTub
Other 1- ~ ~-tA/
_ Eject
_SS
_ Water
FEES: Valuation $ /"SZTD ~
ISSUED BY ~/ ---~.../
/
V'"
Permit Fee Paid $ /a t:"r# Park Dedication $
Date ,~ /;L.--5-gfFinal/O.p. /c> /..27M
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE&>( ~~4 -
A TIOWNER
DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNER
/ ~/. ~..' .~ PLUMBING PERMIT APP..!-ICAT,,;ON
1~-1f:;~"-vy DATE /0 -/?~ PERMIT #
__" _ _ _ PLUMBER L2k' h'4 ~_
1{6'/1
NA TURE OF WORK
SAN SEW 4F 4F
WATER Bathtub Catch Basin
STORM SEW uavatorv Grease Trap
Toile't Sump P1.lmp
INSPECTION DATE INSPECTION DATE Kit Sink Local Waste
ul I tJ //7/11 Sink(other) Site Drain
Shower Laundry Stand p~pe
Floor Drain Laundry Tray
IOp?;h Disposal Wat. Softner
r Dishwasher D. Founta~n
Wa,ter Rea ter Ejector'
Urinals Future outlets
NEW
RELAY
REPAIR
INTERIOR
1** Violation notes on reverse sidel