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CITY OF OSHKOSH N° 37269
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG Al SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 ,s V v a -O PLAN NO.
OWNER"
DESIGNER AA// CD ___e_d__teeZi.
USE /NATURE OF WORK /V-� F
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 re,—(C
BT WH Disp WSoft CBasin
Lav Sh DW DF I San. Sewer I v C
WC FDr
SP Ur __L Storm Sewer C
Sink LTub Eject SS 4_ Water
Other
7'S p 12'w
FEES: Valuation
P ermit Fee Paid Park Dedication
ISSUED BY Date 773
Final /O. P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE a
AGENT /OW /73
DATE
ADDRESS
TELEPHONE
PLUMS' PERMIT APPLICATION 3 7-2-‘7 ADDRESS. `3 tA5 ---6 DATE /S 3 PERICT#
OWNER i i i -f-74 F P
NATURE OF WORE /V a f 0
I
NEW REL AY REPAIR INTE, OR
n v/ C r
SAN SEW
WATER G N'V Bathtub Sump Punk
STORM SEW G Lavatory Ejector
Toilet Water Softener
INSPECTION DATE ran ON DAZE jEit. Sink Drinking Fountain
Sink(other) Urinal
J a 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 side