HomeMy WebLinkAboutPlumbing (laterals) CITY OF OSHKOSH No 11604
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBC1K, SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /�/ MZ f /, PLAN NO.
OWNER - —e4
DESIGNER ,
USE /NATURE OF WORK ,_5 - ....„ ..
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 '� ('-
BT WH Disp WSoft CBasin
Lav Sh DW DF / San. Sewer 11 .
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS ÷ Water
/ y..
Other
UZ-
FEES: Valuation $ 15 'emit Fee Paid $ t Park Dedication $
ISSUED BY /INIP.`./P Date / °z79 el Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE X "U
AGENT /OWNER DATE
ADDRESS
TELEPHONE #