HomeMy WebLinkAbout0043853-Plumbing (laterals) CITY OF OSHKOSH N2 43853
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ,t SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ` 3 .C/A PLAN NO.
• /
OWNER / E
DESIGNER
��r
USE/NATURE OF WORK e 7 4"
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ FueVSystem Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Sent. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR C
- BT _ WH Disp — WSoft — CBasin c,L
- Lav _ Sh _ DW _ DF ( San. Sewer ( t
— WC _ FDr SP — Ur — Storm Sewer
- Sink _ LTub _ Eject _ SS Water ! (��- --
Other
:V
ES Valuation $
FE Permit Fee Paid $ Park Dedication $
ISSUED BY Date °27/ s Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
ENT /OWNER DATE
ADDRESS
TELEPHONE #
APPLICATION t om _ �y
- � - PLDPIDINC DATE >o/ 5� 9 PEffi�T#
� l
ADDRESS , y r /�''
/' ..�� PLUMBER .
owNER,,, ,/ S//
NATURE OF WORE
NEW RZLAT REPAIR / INTERIOR
SAT SEW ► Mt
Bathtub sump Puma
WATER Ejector
STORM SEW
Toilet Water Softener
Toilet
Op DA. Kit. Sink Drinking Fountain
INSPECTION DATE IN Sink(other) Tirin�l,
aterheater Slop Sink
-2 -� --�" phower Grease Trap
loor Drain Local Waste
aundry Tub Site Drain
isposal Laundry Standpipe
ishwasher Catch Basin
c:: ''In
** Violation notes on the reverse side(