HomeMy WebLinkAbout0021103-Plumbing_CITY OF OSHKOSH N°_ 21103
PERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG SIGN ^ ZONING FLOOD PLAIN HEIGHT
------------i-------~-j-~------------~-----------------------------
ADDRESS ~T"/
OWNER I
DESIGNER
USE/NATURE OF WORK
S
PLAN NO.
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
iiEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles .
PLUMBING CONTRACTOR
BT WH
Lav ~ Sh
~ WC _ FDr
-Sink LTub
Other
Volts Amps
Circuits
I~~~'~~~Y,u
Disp WSoft CBasin t.J~-
DW DF -San. Sewer
~ SP Ur Storm Sewer
-Eject SS -Water
FEES: Valuation $ j ~O O/~d~~ Permit Fee Paid $ I ~O ~ a O Park Dedication $
ISSUED BY ~ ~ ~•~~~-~a~. Date /` 'Z 3 ~ Final/O.P. ~ f a 7 r gd
In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction.
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SIGNATURE ~Q .~~~-- 9d
AGENTIOWNER DATE
ADDRESS
TELEPHONE #
ADDRESS
OWNS R
NATURE OF WORK
DATE , ~1/~l~~t! .PERMIT ~~' ~'~~~ ~
PLUMBER ~/~ f~ i'~
NEW RELAY REPAIR INTERIOR
~JoZ ,e
SAN SEW ~k ~~
WATER athtub Catch Basin
STORM SEW avato Grease Tra
Toilet / Sump Pump
INSPECTION DATE INSPECTION DATE Kit Sink Local Waste
' Sink(other) Site Drain
/ Shower Laundry Stan pipe
~-c~-.~. ~ ~ ~ ~ - d 7 - ~~~ Floor Drain Laundry Tray
Disposal Wat. So tner
~ //~ Dishwasher D. Fountain
~Z~
v~^-~' Water Heater Ejector
Urinals Future outlets
PLUMBING PERMIT APPLICATION
** Violation notes on reverse side