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CITY OF OSHKOSH
N2 40441
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG14 SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS PLAN NO.
OWNER f 7'
DESIGNER
USE /NATURE OF WORK i S/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
PLU ING C-- J
BT CONTRACTO
WH Disp WSoft C Basin
Lav lSh _L DW DF San. Sewer
3 WC 1 FDr _L SP Ur Storm Sewer
Sink _LC ktl Eject _SS Water
Other
/t 0
FEES: Valuation d Permit Fee Paid 7. Permit Park Dedication
ISSUED BY Date 7 7 V Final /O.P. 0 -C
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7 I1
A"( AG T /OWNER DATE
ADDRESS i.0J. I A....1 7.30 f
TELEPHONE
PE3 WT APPLICATION
ADDRESS -31 t j L DATE 7/ 0 T#
s g
NATURE OF WORE W
NEW RELAY BpAIB 1 /INTERIOR
SAN SEW
WATER_ i Bathtub r 7 Sump Putty
STORM SEW Lavatory �j Ejector
Toilet I1! Water Softener
INSPECTION DATE INSPECTION Kit. Sink l Drinkin Fountain
Sink(other) Urinal
L i( Waterheater l Slop Sink
"l x Shower F Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
R 1 vL 8 r 0 i Disposal Laundry Standpipe
Dishwasher! Cat h Basin U „i... t /1V -.Lam. r v. i c 4 44#11- F� /i s 7-73"C5
Violation notes on the reverse side]