HomeMy WebLinkAbout0025967-Plumbing (laterals)n CITY OF OSHKOSH N° 25967
`' PERMI T -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELE
------------------- ^ PLBG ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS 3 ~ ~ PLAN NO.
OWNER ~ ~~'~
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 ^ Fu I/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Chan e ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLllMBING CONTRACTOR
- BT WH Disp WSoft CBasin
Lav Sh DW DF ~ San. Sewer ~ ~~ ~-
WC FDr SP Ur -Storm Sewer
-Sink LTub Eject SS ~ Water
Other
FEES: Valuation $ ~~~ ~ • ~ i ~ Permit Fee Paid $ a d ` ® ~ Park Dedication $
ISSUED BY ~ Date ~ ~ ~ °~' 3 - 9~ Final/O.P. fC~ - /~ - q/
In the performance of this work I ag a to perform all work pursuant to rules governing the described construction.
SIGNATURE T l-'p~X,y° /~~5~ 3.3.1 /O-?3•--4~
ENT/OWNER DATE
ADDRESS ~~~~ ~ '~-P~ Gt1~i S~f'~i 3~ Go~S=S~7~o~
TELEPHONE #