HomeMy WebLinkAbout0012104-Plumbing (replace fixtures) CITY OF OSHKOSH N° 12104
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG JRC SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /0/ /7 1/ ��
PLAN NO.
OWNER F/'wr.,c S £O-,,4T-4i
DESIGNER 4 USE /NATURE OF WORK U c �` _,
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ NC ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 4 , .. �
BT r
WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
_L WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
V
FEES: Valuation $ Permit Fee Paid $ / Park Dedication $
ISSUED BY --�
-___-",-6,1Date / (1 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 1,i_ _ - i /,G�!l61� PS-10 / AGENT /OWNER / // 277 / / DATE
ADDRESS
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