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CITY OF OSHKOSH N- 41574
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG [� SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS -- / PLAN NO.
/ 4 / _ /
OWNER
DESIGNER �f�
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
BT _ WH _ Disp _ WSoft — CBasin ,"
Lav _ Sh _ DW _ Y DF 1 San. Sewer ( tI C "
WC FDr SP Ur Storm Sewer
Sink _ LTub _ Eject _ SS Water /
Other
FEES: Valuation $ ..2-- 6> 0 0 - O d Permit Fee Paid $ ° ' ®6 Park Dedication $
ISSUED BY _____,Z7.------ Date 9A Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
•r k, : - . i
AGENT/0 , - DATE
ADDRESS
TELEPHONE #
FLING EMIT APPLICATION Yd a-
ADDRESS j-4 Y.- -S� DATE 9///,' PERMIT# `.i 7
OWNER 4
NATURE OF WORE , , % ,• / % � '�4
NEW REPAIR 1 I INTERIOR
SAN SEW
'STATER #
Bathtub
STORM SECT Sum Pu
Lavatory
_Ejector
oiler
INS_ PEC ni IN Water Softener
TE Kit. Sink Drinking Fountain
Cicr-e---42---z-sxei ) Sink(other)
��/��- Urinal
Waterheater Slop Sink
0 / /; 0 l �/J Sh --owe Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin