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CITY OF OSHKOSH
No 39439
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG /,4 SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 9� PLAN NO.
OWNER S i
DESIGNER A/ �fy
USE /NATURE OF WORK /Y v z
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 _f 1
s
BT WH WSoft CBasin
Lav Sh DW DF San. Sewer KU V c
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS t Water l
Other
FEES: Valuation ,S i151 /2 0 0 4 Permit Fee Paid 'IL- cD' 0 0 1 Park Dedication
ISSUED BY At/ Date Y
Final /O. P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 11/ i
AG} /OWNER DAT-
ADDRESS i' ,,r ,_.?1' e3
TELEPHONE
4/,...6 PLUMBING PERNIT APPLI ON
PiDD RES S
/,/..2._ �f 7)4_ PEffiaT# 3 5)
OWNER S .-.0 1 1:.4:
NATURE 07 WORE O=7.1 4
NEW RELAY REPAIR re OR
SAN SEW Kid c
WATER Bathtub Sump Pump
STORM SEW Lavatory Ejector
Toilet Water Softener
NSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
Sink(other) Urinal
1,1,V4(4:: �j Shower Slop Sink
Shower Grease Trap
Floor Drain Local Waste
SD Laundry Tub Site Drain
J Disposal Laundry Standpipe
19 /rf Dishwasher Catch Basin
/,040
Violation notes on the reverse side
1.