HomeMy WebLinkAbout0017133-Plumbing (storm water separation)~ CITY OF OSHKOSH N°_ 17133
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~, SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS / ~d Z ~! ~" ` ~ " ~~~d PLAN NO.
,[.~ ~
OWNER ` , ~- ~ ~G" C-
DES
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ~L
BT WH
Lav Sh
WC FDr
Sink LTub
Other
Disp
DW
SP
-Eject
# Stories Height _
Class of Const. Occupancy Permit
WSoft
DF
Ur
SS
CBasin
San. Sewer_
Storm Sewer
r
°'~ /B
FEES: Valuation $ Permit Fee Paid $ ~~ ~" ~ Park Dedication $
ISSUED BY Date a ~~ -" P~- Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
v ~~
SIGNATURE
Sq. Ft
# Rooms
4'
ATE
ADDRESS ~ ~_-~/1~~Cd~l2~ ~ ~~ I ~ ~P / d
TELEPHONE #