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HomeMy WebLinkAbout0039108-Plumbing (laterals)~~ / ~ CITY OF OSHKOSH N° 39108 `' PERMIT -APPLICATION AND RECORD TYPE: BLDG ^ HTG ^ ELEC ^ PL G ,~J SIGN ^ ZONING FLOOD PLAIN HEIGHT ------------------------------------------ ADDRESS ~~ OWNER DES USE/NATURE OF WORK-~~ _ BUILDING CONTRACTOR Size Sq. Ft Foundation PLAN NO. # Rooms # Stories Class of Const. Height . Occupancy Permit HEATING CONTRACTOR Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR Electric Serv. New ^ Change ^ Fixtures Switches Temp ^ Type Receptacles Volts Amps Circuits PLUMBING CONTRACTOR _ ~'( - BT - WH - Dis P - WSoft - CBasin - Lav - Sh - DW - DF o __~__ San. Sewer_ ~T ~G - WC .- FDr _ SP - Ur Storm Sewer -Sink _ LTub -Eject - SS ~ Water ~ ~~~ Other FEES: Valuation $ 3 CDa .d ~ Permit Fee Paid $ 2- ~ ~ ~ ~ ISSUED BY ~f 'z ~ ~ Park Dedication $ ~ Date -~ Final/O. P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE~2=~~ iA~ ~.l~~Q,33o1~ ~/ AGENT/OWNER ~ ~_ ~~ r~9 DATE ADDRESS d y~ `/ 5~~,. (ry~ TELEPHONE # ~;nDaESS $~ °~ OWNEB .'~~ NA10R~ OF WCRF ~ _ ... ,...., ~~i/ C ~~~ ~~ /~ T j`6 / ~ta~nac ~s~'r cazzo ~T ~ j,~~~ ~ ~ ~ 9/,~s~ T~ Lavato Ejector Toilet Water Softener ~~p Dpg Rit. Sink Drinkin Fountain - Sink(other ' -,_... .. ~ ___L__.,... Slot/ Sink Laundry lu Dis osal Dishwasher ~3 rp v o . eJ Laundry Stagy Catch Basin ** Violation notes on the reverse eide_