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CITY OF OSHKOSH N ° - 37958
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG /6
Jr] SIGN 11 ZONING FLOOD PLAIN HEIGHT
ADDRESS / 7 / q� 7 PLAN NO.
OWNER B�rn-
DESIGNER ,/�
USE /NATURE OF WORK ,t/�-'f 1 `
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 ian. Sewer
WC FDr SP Ur ( Storm Sewer V,v C---
Sink LTub Eject SS W Water
Other
FEES: Valuation $ /663 O Q' Permit Fee Paid $ f C' ° a *�/ Park Dedication $
ISSUED BY Date °7`/ Final /O.P.
In the performance of this work I agree to p- - . ork pursuant to rules governing the described construction.
SIGNATURE
AG /OWNER DATE
ADDRESS
TELEPHONE #
/ 7G i� /
/ ��P/LUm I PERMIT APPLICATION
ADDRESS, -44-3-1 -�X DATE . , /- .9 7 / . Y ,
OWNER 2 .4: , ,�'
NATURE or WORK w-SFe - ® / / .
NEW RELAY REPAIR • RIOR
SAN SEW # #
WATER Bathtub Sump Pump
$TORN SEW Y64I Lavatory Ejector
Toilet Water Softener
INSPECTION DATE LRSP DATE Kit. Sink Drinking Fountain
zr � /J � � S 1IIk� O Chlr)
- Slop p S
�c ��/ � - 3.laterheater Slop Sink ____
,i.:_tc.,_€,e,4,,,ti Flower Floor Drain _ , Grease Trap
Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
,Dishwasher Catch Basin
** Violation notes on the reverse side{