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CITY OF OSHKOSH N° 43020
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 6 /7 g -r--€-z-
PLAN NO.
OWNER :::.
DESIGNER
USE/NATURE OF WORK / 1 -S /- - 0 - - c - - e - / - Z ,- - - 7- I
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
____ ..e_____e
PLUMBING CONTRACTOR
— BT _ WH _ Disp — WSoft _ CBasin -------
— Lav _ Sh _ DW _ /� DF 1 San. Sewer Y `i)
_ Al - WC _ FDr _ SP Ur ! Storm Sewer Y / C
— Sink LTub _ Eject SS T Water /
Other
FEES: Valuation $ /6 C C ' 0 c Permit Fee Paid $ 3 0 ' Q � ' 1
Park Dedication $
ISSUED BY Date / '"X / 7 -. Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE £1'4 9'2°9/2 S e' 3 3? 4)- g 9i/
�/ AGENT /OWNER DATE
ADDRESS r z/d-y ��� Cam° 1, -,-',,.,C /- - s %'+- at 397 < --
TELEPHONE #
D1� PENIIT APPLICATION »o
ADDRESS. /2 T /'/ DATE r l RIII ?# . 0 �-'
OWNER . F PLU ER � . / � r
NATURE OF WORT , )4/=:',
RELAY REPAIR INTERIOR
SAN SEW #, #
WATER Sump Pump
STORM SEW 1i Lavatory Ejector
Toilet Water Softener
INSPECTION DATE INSPECTION DAB _ Kit. Sink Drinking Fountain
Sink(other) Urinal
5-8 � `�_ �7 Waterheater Siop Sink
i fi f Shower Grease Trap
(t� : /.; O �- Floor Drain Local Waste
/,, ' � _ Laundry Tub Site Drain
1
Disposal Laundry Standpipe
ye / / //7
Dishwasher Catch Basin
** Violation notes on the reverse sidet