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C :11) CITY OF OSHKOSH N 38543
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS g s L
PLAN NO.
OWNER 1
DESIGNER /(//S/7"- �r
.e....e. L s Z if____I g,
USE /NATURE OF WORK V
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
i
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW DF (San. Sewer "V 6 C
WC FDr SP Ur Storm Sewer W
Sink LTub Eject SS Water l
Other
FEES: Valuation 6 0 a 0 Permit Fee Paid 3. 0 C) C Park Dedication
ISSUED BY ,(7 Date Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 2/Pee-CD 3,1'1 -`m 5 f --9,
AGENT /OWNER DATE
ADDRESS4 7 11/1,: i -rt or- e,R. 5 V1,,'G 11.-)"_597
TELEPHONE
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PLUMING PEBIIIT APPLICATION
ADDRESS. /0 I 0G 1 Id d DBE i Q2 .9 `T PER IIT# 6 s
OWNER 5� u
p A: �f P, -G� �1`�Q Y
NATURE OF WORD O
l
NEW RELAY REPAIR
SAN SEW
AR Bathtub Sum. Pu Ai
STORM SEW Lavatory Ejector
Toilet Water Softener
ON DATE INSPECTION DATE Kit. Sink Drinkin• Fountain
Sink(other
Urinal
Waterheater Slop Sink
Shower Grease Trap
.i Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
Violation notes on the reverse side{