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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
26686
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USE/NATURE OF WORK
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)U.~ .s~f{- 6 ~ M/
PLAN NO.
ADDRESS
OWNER
DESIGNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 NC 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
L-
f) Cl--v7
_Disp
_Sink
_FOr
_ L Tub
_OW
_SP
_ WSoft
_OF
_ CBasin
~ San. Sewer
w~
_BT
_WH
_Sh
c.,c fJ:J C
_Lav
_WC
_Ur
_ Storm Sewer
~ Water
_ Eject
_SS
I C-c-
Other
FEES: Valuation $
/,.?ocJ.o C)
Permit Fee Paid $
W .~~~
/
;:t-6.o J./
/:2 -Ie; -0//
Park Dedication $
Final/O.P. It) --~j -$" I
ISSUED BY
Date
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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A-€~
1 /' .- / .,{- :;7/
DATE
ADDRESS
'r- /;7.." ~ ,- ,'"'
) g..L.. /,.A-' c} J.-
TELEPHONE #
OWNER
NATURE OF WORK
NEtV'
PLUMBING PERMIT APPLICATION
DATE /0,- .3 I r- 7 /
PLUMBER ~
~ lli' ~ =' L -I- c7 ~
PERMITiF :J G b {; h
SAN SEW 'IPJ C # iF
WATER I Cv<- Bathtub Catch Basin
C:'!:'TJ Lavatorv Grease Trap
Toilet I Stmlt) Ptiuro-
INSPECTION DATE INSPEcnON DATE Kit. Sink' Local Waste
S/L0 /Ou31{P~!) Sink( other) Site Drain
Shower Laundry Stand hpe
Floor Drain Laundry Trav
Disnosal Wat. Softner
, Dishwasher D. Fountain
Wal:"er Heater Ejector
t' Th.; " al !'l Future outlets
RELAY
REPAIR
INTERIOR
1** Violation notes on th~ reverse sidel