HomeMy WebLinkAbout0025107-Plumbing (laterals)P _CITY OF OSHKOSH N° 25107
ERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS
OWNER
PLAN NO.
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft.
Foundation
# Rooms
# Stories Height _
Class of Const. Occupancy Permit
HEATING 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
- Disp - WSoft - CBasin wd
DW - DF ~ San. Sewer y ~~ P U ~
- SP Ur -Storm Sewer
-Eject SS ~ Water ~~ e 4
FEES: Valuation $ O~ Permit Fee Paid $ o~ d. rO Park Dedication $
ISSUED BY ~ Date _ 9 " 3
l Final/O. P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~ C'--+~Lo ~~//°af'.S 8
~ ~~ 9'-3-y~i
AGENTIOWNER
DATE
ADDRESS
TELEPHONE #
ADDRE
OWNER
NATURE
AN SEW 0~ C ~ ~
WATER ~~ Bathtub Catch Basin
Lavato Grease Trap
Toilet I S P
N PECTION DATE INSPECTION DATE Rit. Sink Local Waste
_ Sink other Site Draia
j ~ ~ ~~ Shower Lauadrq Stand Pipe
loot Drain Lauad Tra
Dis Deal Wat. Softaer
Dishwasher D. Fountain
Water Heater Effector
Future outlets
** V' on a rev rse side
1vF'Ta RET.AY REPAIR INTERIOR