HomeMy WebLinkAbout0012881-Plumbing (laterals)
~
CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
12881
TYPE:
BLDG D HTG D ELEC D PLBG)l1 SIGN D ZONING
FLOOD PLAIN
HEIGHT
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Lc/L/-./CA'~L~-r~<;j i' (&~-kv,~~
OWNER
DESIGNER
..S"t" --< ~/'-- a p~A /t:"A/a~/.
USE/NATURE OF WORK
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
C/J-rJ/f S ~/L
_BT _WH _Disp
_Lav _Sh _DW
_WC _FDr _SP
_Sink _ L Tub _ Eject
Other
_DF
_ CBasin
-1. San. Sewer 41 t'~ .;? yr ~.
,
_ Storm Sewer
-L Water / Yr CCf);-r€ A,~_
_Ur
_SS
FEES: Valuation $ ~UJZ) (~--_.
ISSUED BY ~/1 f7/?/
Permit Fee Paid $
Date
"
~~'
9":- /? ~d
,
Park Dedicatio, n $ ~,'
Final/O.P. 4h/i:-
,
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREr ~
AGENT/OWNE
ADDRESS
If..- /1 - 31
DATE
TELEPHONE #
ADDRESS
OWNER
NATURE
~ ~_ PLUMBING PER..'fi'I APPLJ;CAnON
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_~_Z~~_---E-/-E ' PLUMBER ,_/f._T~,'~,h--?(/
OP,WORK ,~~
mv RELAY REPAIR IN'l'ERIOR
SAN SEW Ie./~ iF iF
WATER "l 'fCr7/'1/1 Bathtub, Catch Basin
~'1'hm.f ~'FU · f Lavatorv i Grease Trap
Toilet I Sumtl Pumo
INSPECTION DATE INSPECTION DATE Kit. Sink Loc a1 Waste
Sink( other) Site Drain
D I ~II()I Shower Laundry Stand PJ.pe
11 Floor Drain Laundry Trav
; " Disposal Wat. Softner
.Ii fo~J Dishwasher D. Fountain
ciut~ 1 Water Heater Ejector
TT..i." ", s Future outlets
;;2/3
r '1111151
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f** Viola don notes on' the reve'rse sideJ