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CITY OF OSHKOSH
N2 40642
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG fr SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS //3/ 5 --e 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 Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR �r� d 6
BT WH Disp WSoft CBasin V.
L av L Sh DW DF San. Sewer
WC C FDr _L SP Ur Storm Sewer
Sink LTuub I Eje SS Water
Other /5 W grr
es o a,0 i
FEES: Valuation Permit Fee Paid d Park Dedication
ISSUED BY d Z Date %7' f Final /O.P. if 9V
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /lu in P 2 3 3 2— As" ifi
AGENT /OWNER' DATE
ADDRESS
TELEPHONE
PLDsINC PERMIT APPLICATION
ADDRESS.'
DATE S-//g/ PERMIT# 6 K 2 OWNER S 0 e
NATURE OF WORK -S'
NEW RELAY REPAIR i, RIOR
SAN SEW
WA=R Bathtub 1 t Sump Puna
STORM SEW Lavator9 fl Ejector
'Toilet (1
Water Softener
DATE INSPECTION DATE Kit. Sink f Drinking Fountain
7/// urinal
Sink(other)
1 l Waterheater Slop Sink
1 Shower l Grease Trap
Floor Drain Local Waste
1 Laundry Tub Site Drain
Disposal Laundry Standpipe
Dish asher i Catch
v l 1 P
0
notes an the reverse side(