HomeMy WebLinkAbout0005067-Plumbing (cross connection)~ CITY OF OSHKOSH N°_ 05067
`- PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG~] SIGN ^ ZONING FLOOD PLAIN _ HEIGHT _
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ADDRESS ~~ ~`~ ~~ lJ PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
# Rooms
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles
Volts Amps
Circuits
BTU'S
PLUMBING CONTRACTOR -
_BT _WH
Lav
- WC
Class of Const
# Stories
Height .
Occupancy Permit
Sh
FDr
Disp
._ DW
SP
WSoft
- DF
Ur
CBasin
-San. Sewer_
Storm Sewer
Sink - LTub -Eject SS -Water
Other ~ ~ v~
FEES: Valuation $ ~~ ~- / Permit Fee Paid $-. ~ Park Dedication $
ISSUED BY ~ ~s'{ Date Final/O.P. Z ~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
Heat Loss
DA
ADDRESS ~ TELEPHONE #