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HomeMy WebLinkAbout0030654-Plumbing (addn fixtures) ~ CITY OF OSHKOSH PERMIT - APPLICATION AND RECORD N2 30654 ~~P_E~ _ _ ~L~~ _~ _ ~T~ _ C? _ ~~E~ _ C? _ ~~B~~~I~~ _~ _ ~O_N~N~_ __ _ _ _ _F~~~D_ ~~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _ .J-oy..S- H~ LA! ~~~ USE/NATURE OF WORK F ~ ~ ~ ~ / ~tF ..z.g- '/7,Y ADDRESS PLAN NO. OWNER DESIGNER BUILDING CONTRACTOR Size Foundation Sq. Ft. # Rooms # Stories Class of Const. Height Occupancy Permit HEATING CONTRACTOR Heat 0 AlC 0 Vent 0 Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR Electric Servo New 0 Change 0 Temp 0 ~ Type Volts _ Amps_ Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR c ~ _Disp _ WSoft _OW _DF _SP _Ur _ Eject _SS _ CBasin _ San. Sewer _ Storm Sewer _ Water ~ _BT hav _WC _WH _Sh _Sink Other _FOr _ L Tub FEES: Valuation $ 5LS-6 ,0 Cl ~ Permit Fee Paid $ Date /t> . 0 c\ Park Dedication $ Final/O.P. /~ -14 -C}-a. ISSUED BY '7-/b -j? L- In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE~ 4- /J'1 ~ 1J?1' t;?U T -/0- 7' ei'- ~AGENT/OWNER DATE ADDRESS U/ 7'1/0 ti/1J1~ f!j"t?A?' ~ a 7F~!fof:f ~ ~/kfC;"~11 W, s-tJ1/j- ,/ /- - - - - - - - _, - - - I . . ~. Pt.lIIIB Il'IC PEIl1ll'l: APPUCA:rtOll ADDRESS do)Cs- . i-"V amn ~k~ KAna OF ~0lUC . I . __ ~ ~~i NEt. RELAY REP AU SAN SEtW iJAmR ON 'DAm msncnOR DAm F' 0(1 '1"/,1.- /J~~ 1'12-" ? ~ cf <1/7- I ~ {; ~j(>-~~(f2- ** Viola~ion no~es on the reverse sidet 30~S-Y I