HomeMy WebLinkAbout0039110-Plumbing (laterals) N2 39110
CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZON ING F
FLOOD PLAIN HEIGHT
ADDRESS ,t✓ ye PLAN NO.
OWNER
DESIGNER
�-C 6
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
I I
PLUMBING CONTRACTOR ie a
BT WH Disp WSoft CBasin
Lav Sh DW DF t San. Sewer
WC FDr SP Ur Storm Sewer V C
Sink LTub Eje SS Water
Other
FEES: Valuation 2-140 0 6 Permit Fee Paid 5 O e Q
Park Dedication
ISSUED BY i Date �7Y Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR 7',S[233, q-- d 7 7
AGENT /OWNER DATE
ADDRESS g V srz- cd Gv Gl S-_vy 949=s -v- 3f- -7
TELEPHONE
PL 2NIT APPLIWfiI N
ADDRESS a hi 'i /.r miner DATE Y
---?-27/ b
CNNER ,1:. C
NATURE OF WORK ii �..r.
RELAY REPAIR *s r RI
WATER 4.4WAM J _MI Bathtub Sul. Pu
41 y lA III3rL4 III Lava to Ejector
Mil Toilet Water Softener
4 •1_, ON DATE INSPECTION DATE III1Kit. Sink Drinkin• Fountain
Sink(other
W e heater Slo. Sink
c_ e-e' r Ri ease Tram
Floor Drain Local Waste
Ell Laundry Tu. Site Drain
Dis•osal Laundr Stand•i.e
11 Dishwasher Catch Basin
�y
92 /D et)
Violation notes on the reverse side]