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CITY OF OSHKOSH
N2 35447
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG le SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /,z O SGZticf- ¢JC —C PLAN NO.
OWNER s ..4
DESIGNER i
A/
USE /NATURE OF WORK 4 S at 0-) ____c__...-te:eZ/
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 Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft
CBasin
Lav Sh D W DF t San. Sewer T J C
WC FDr SP Ur Storm Sewer f I) C
Sink LTub
Eject SS Water
Other
FEES: Valuation g
Permit Fee Paid 5 0 Park Dedication
ISSUED BY Date �l Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE
Vo/
nom= PERMIT APPLICATION
ADDRESS 2-(=> S DATE g/ PERMIT# 3
OWNER g 1 -4: S
NATURE or WORK 6 "OS
NEW RELAY REPAIR C i. RIOR
SAN SEW y r J c
WATER Gam.- Bathtub Sump Pump
ST ORM SEW `r 9 Li L— Lavatory Ejector
Toilet Water Softener
INSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
v e� V W a t e r eats S pal
Waterheater Slop Sink
C /1°'' Shower Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
Violation notes on the reverse sidet