HomeMy WebLinkAboutPlumbing (laterals) CITY OF OSHKOSH
N9 1
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG J �SIGN ❑ ZONING FLOOD PLAIN HEIGHT
�1(af��� / PLAN NO.
ADDRESS AV
/?27
OWNER 2�
DESIGNER
USE /NATURE OF WORK ��L/l/ ir----1 4 .fG ',
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 U yn S (Q' 4:--,-6-- . 74-,
BT WH Disp WSoft CBasin
_Lay Sh DW DF 4 San. Sewer
�'/ C
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water / y f —
Other
FEES: Valuation $ ,�, .Q" Permit Fee Paid $ Park Dedication $
ISSUED BY - >, / Date /02-4? c rd Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE "
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PL i, B: LNG PERMIT APPLICA N // 1 (
ADDRESS � • � # 4 / D TE ( S l�� PERMIT#
OWNER Lai . OvI' toles c UMBER , TVL 4 - lr42i1
NATURE OF WORK . S' --c-L,
NEW RELAY REPAIR INTERIOR
Le
SAN SEW ; # mit—
WATER `-t Bathtub batch Basin
STORM SEW
Grease Trap
Toilet
INSPECTION DATE INSPECTION DATE Kit. Sink L oma P Was
Local Waste
Sink(other) Site Drain
Shower =Laundry Stand Pipe
r?//,---x,, Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
Urinals Future outlets
t Violation notes on the reverse j idel