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CITY OF OSHKOSH N 39563
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG J f SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS `sue r
PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK /f /S n
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 /T
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer C.
WC FDr SP Ur Storm Sewer /I/ C
Sink LTub Eject SS Water L`—
Other
FEES: Valuation /3° (3 /0 6 Permit Fee Paid 30 0 0 Park Dedication
V ISSUED BY Date Z inal /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE t o r t e r 3 6 ;C g0 31 5— 5 v 5
AGENT /OWNER DATE
ADDRESS Y 2 G" 14/6n,44,("'.P Slot 34 7S✓
TELEPHONE M
th i$ qj IND PERI? AYPLI ON ADDRESS. 57 Id a/ DM 9 32 S
OWNER (J S 0 !1L F ERMI
NATURE OF N �'F clZ PLUMBER K1 l',�J(I
NEW RELAY REPAIR INTERIOR
SAN SEW 4/
W• TER if
y /411111 Bathtub Pu
Lavato Ejector
Toilet Water Softener
/NSPECTION DATE INSPECTION DATE .Nit. Sink Drinking Fountain
/��f
Sins (ogler) Urinal
Waterheater Slop Sink
,Shower Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
Violation notes on the reverse sidel ‘,..3 d` rd