HomeMy WebLinkAbout0041388-Plumbing (laterals)~~~
/~ CITY OF OSHKOSH N~ 41388
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG [~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ~ ~~/ -5--~~'
~ ~~(/~'~ ~ PLAN NO.
OWNER
DESIGN
USE/NA
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation 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 Volts
Fixtures Switches Receptacles Circuits
Amps
PLUMBING CONTRACTOR '-'~ l~~
- BT - WH - Disp
-Lav _Sh -pW
- WC - FDr - gp
-Sink - LTub -Eject
Other
- WSoft - CBasin
- DF ~ San. Sewer ~ ®~ ~
- Ur ~ Storm Sewer ~~/~c`
- SS ~ Water l `-_~
FEES: Valuation $ l~~ d ~ d O Permit Fee Paid $ ~ ~ Q Q Park Dedication $
ISSUED BY ~~~ Date ~ ~ ~ SIB Final/O
P
.
.
In the pertormance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /` _` ~ pZ ~' f
'J ~ AGENT/OWNER L
ADDRESS ~q'S~/ (~ ~ f /S~ ~/G/~O
~~ sg~ DATE
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TELEPHONE M