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CITY OF OSHKOSH o
N_ 12518
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS %�qZ ��� /1 PLAN NO.
OWNER e'���
DESIGNER
USE /NATURE OF WORK
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 gee..4 k
BT WH Disp WSoft CBasin
Lav _ Sh DW _ DF San. Sewer r�
- WC _ FDr SP Ur Storm Sewer
- Sink _ LTub Eject SS _ / (/ L Water / Crr-C.
Other
. /
FEES: Valuation $ ` Permit Fee Paid $ ,,2 uC Park Dedication $
ISSUED BY Date ---? -- Final /O.P. '
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE t / /° ,�( 3 2-" 3'9
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
/ / PLUMING RMIT APPLICATION
ADDRESS ( 6 g'2 fi. , -1 I DATE — PERMIT# _ 1.2-A7 g
OWNER rr / PLUMBER
NATURE OF WORK G'-C.a/ , _,L r- j- CT7 / P S w .c
NEW RELAY REPAIR _INTERIOR
SAN SEW i v # #
WATER `r Bathtub Catch Basin
STORM SEWI / _ Lavatory j Grease Trap
Toilet 1 Sumo Pump
INSPECTION DATE INSPECTION DATE Kit. Sink 1 Local Waste
Sink(other) Site Drain
r 3 / Shower
Floor Drain Laundry Stand Pipe
Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
Urinals Future outlets
j** Violation notes on the reverse side(