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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
28166
TYPE: BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
OWNER
cf)-~ fA) 9 {frf ~
i~J~ C-~
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
L7
(-52 - I~
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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_
FixtuJes Switches
Receptacles
Circuits
PLUMBI~G CONTRACTOR J
(~
w~
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
~Sink _LTub ~Eject _ _SS _ Water
Other I - f) t!.-tAJ ~
ISSUED BY
Permit Fee Paid $
Date
I 6 . at> V
V/"'- / / ~ ::l-
/ /
Park Dedication $
FEES: Valuation $ ID '7 a. . c 0
wi<::-
Final/O.P.
'5"-5-9:/
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
cf!h
/Y'O J.
Cu~
, AGENT/OWNER
ADDRESS
s- f'~
1--)1,.- 'f7.
DATE
..233-6?'f }
TELEPHONE #
nmtBING PEIUaT APPLICATION
ADIlBESS Y -2 <: CJ -:7 ~ hL---- IlA:rl! V /"' I h ~ PIlllHIU ;Z J' / ,;; c:
OIIREll - Cd{ V~ ?-~"', ~ I'I.llIlIlU. Q.. If ~
l'lA%tlU OF IlOIIIi: C ~ If -"" -~ I":a ~
NEtl :r REPAIR RIOR
I
SAN smw # I .
wAl'ER Bathtub Sumn Pumn
~'Il'U wva1:on Ej ector
Toilet Water Softener
ON DAn tNsnCTION DAn: 7 lCi 1: . Sink Drinkin I< Fountain
Sink(oCher) n . 1
r "rS/s Wate"'heater Slop Sink
Grease Tran
Floor Drain Local Waste
j, Laundry Tub Site Drain
Disposal I Laundrv Standpipe
Dishwasher Catch Basin
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** Violat:ionn.ot:es on. ehe reverse side1