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CITY OF OSHKOSH 40912
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG e SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 0' /°Z- S - - / PLAN NO.
OWNER .......---a-Z__
k
DESIGNER
USE /NATURE OF WORK - 34- .---1-0--d- / / t
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 (- p,
BT WH _ Dis p _ WSoft _ CBasin
Lav / Sh _ DW _ DF _San. Sewer
_12WC _ FDr _ SP _ Ur _ Storm Sewer
_L Sink / iob 4 — Eject — SS — Water
Other
FEES: Valuation $ 30C) a • 0 0 Permit Fee Paid $ `' 0 0 ✓ Park Dedication
ISSUED BY ∎' ' Date y/9 Final /O.P. /-e= g ' gLi
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE ,. "--4.— ii;- GENT •
/OWNER DATE
ADDRESS
TELEPHONE #
PLUMB PERMIT APPLICATION K'd
iDDRESS 57 - z ,01.
DATE . 6/`-2 V/9 K PERMIT# . ,'/ Z
o '
OWNER -42---- A - i_ • .. ..4- 6 - i --
N A T U R E O F W O R K 4 'A I I W- rI
NEW RELAY REPAIR INTERIOR
SAN SEW # #
WATER Bathtub
Su Pu o•
STQRM SEW Lavatory Ejector
T Toilet 1 Water Softener
INS_ ON DATE INSPECTION DATE 1 tit- sink ,_ Drinking Fountain
Sink(other Urinal
, / Waterheater / Slop Sink
1 Shower / Grease Trap
b f D Floor Drain Local Waste
Laundry Tub Site Drain
V.0..// Disposal / Laundry Standpipe /
/ Dishwasher Catch Basin
** Violation notes on the reverse side]