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~ CITY OF OSHKOSH N°_ .15634
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ~, PLAN NO.
OWNER ~~lvc- ~ ~ b~
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles
Heat Loss BTU'S
Volts Amps
Circuits
PLUMBING CONTRACTOR ~~Q. ~ 'e
BT WH Disp WSoft CBasin
~,
Lav Sh DW DF San. Sewer ~llG
WC FDr SP Ur ~ Storm SewerT7~UL
-Sink LTub Eject SS ~ WaterT~'~/.~ ~
Other
a7 pp
FEES: Valuation $ ~~~ Permit Fee Paid $ ~-7~.q Park Dedication $
ISSUED BY ---/r Date / ~~~ ~ Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
ADDRESS
DATE
TELEPHONE #
ADDRESS '~ C
OWNE R
NATURE OF WORK _.~
wTC T.t
u
nL`T Av DFDAT4
PERMIT APPLICATION
_ DATE ~ `j ~~ ~ /PERMIT/'"` ~~.~
_ PLUMBER ,~ ~ ~ c ~~~
TNTRRT (1R
SAN SEW `~ ~~ ~~
WATER athtub Catch Basin
STORM SEW a avato Grease Tra
Toilet Sump Pum
N PECTION DATE INSPECTION DATE it Sink Local Waste
Sink other) Site Drain
Shower Laundry tan pipe
Floor Drain Laundry Tray
Disposal Wat. So tner
Dishwasher D. Fountain
Water.Heater Ejector'
Urinals Future outlets
** Violation notes on reverse side