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CITY OF OSHKOSH N2-41117
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBGSIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 7 3/ s 4 PLAN NO
OWNER g
DESIGNER
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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
1 BT 4 WH Disp WSoft CBasin
Lav Sh t DW DF San. Sewer
WC FDr _L SP Ur Storm Sewer
Sink —f—t-Tub Eject SS _Water
Other
FEES: Valuation Permit Fee Paid Park Dedication
ISSUED BY Date VV Final /O.P. /1 95`
In the performance of this work I agree to perfor all work pursuant to rules governing the described construction.
-/--L SIGNATURE j Ic l
AGENT /OWNER DATE
SSA /2_ ADDRESS G `r-ze. v/j J 2(j 2Q�'S
TELEPHONE
t., PERMIT APPLICATION �Q/
ADDRESS ?6,?/,
OWNER i, DATE PERNIT# K /%/7
PLUMBER (7 7
NATURE OF WORK /f/s A .3 5-04)
NEW RELAY REPAIR INTERIOR
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WATER
TORp,L S1 I Bathtub Sump Pump
Lavatory/ j Ejector
INS N DATE Toilet Water Softener S
i Drinking Fountain
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U
9 ;)q, X` T Waterheater7 Slop Sink
f ,Shower Grease Trap
Floor Drain I Local Waste
Laundry
D Y Site Drain
Disposal Laundry Standpipe L____ f 1 Dishwasher Catch Basin
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4 j ib F P 11 i V 11:s
IA tr (5/1742/'- 4 m .2. i des on the reverse s a. elitto