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CITY OF OSHKOSH N 36966
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG to SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS v V
i v V
Q PLAN NO.
OWNER 1
DESIGNER
USE /NATURE OF WORK AZ-Cf Z,_ t 4
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 I(
BT WH Disp WSoft CBasin c1 Q
Lav Sh DW DF I San. Sewer 7 v C
WC FDr SP Ur J C
Storm Sewer
Sink LTub Eject SS _L Water l e
Other
FEES: Valuation 2 D O g O, p
Permit Fee Paid Park Dedication
ISSUED BY Date 1�/V73 Final /O.P. /o/ `1 q
3
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE �E+ 2 o 33 .)'S` ///6- 9
p AGENT /OWNER DATE
ADDRESS O yo2 V 5 /P,, 0 C ri ee C S` V9/ S'-1o) 59 2 5°
TELEPHONE
a 8efro. ept, 5
y PLUMBING PERMIT APPLICATION
ADDRESS. q I1 S 4 LZt J d1 DATE /D- I -"I 3 PERNIT# 36 9 6
OWNER PLUMBER TPA (a-atd
NATURE OF WORK jAljak
NEW RELAY REPAIR INTERIOR
SAN SEW `/4-149V C"
WATER l- Bathtub Sump Pump
mot ca. rG Lavato Ejector
Toilet Water Softener
INSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
Sink(other) Urinal
y� $r S' Go 73 yaterheater Slop Sink
Shower Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
Violation notes on the reverse side(