HomeMy WebLinkAbout0026403-Plumbing (lav) CITY OF OSHKOSH N9 26403
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGX SIGN ❑ ZONING FLOOD PLAIN HEIGHT
/ C3 '
ADDRESS Lam. - P N NO.
OWNER ...o 7 ir
or 'l
i
DESIGNER
USE /NATURE OF WORK = -- r
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
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation 3 S'b , 0 0 l0 . cA 0 `'
S aluation $ Permit Fee Paid $ Park Dedication $
ISSUED BY Date
3 , r Final /O.P
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ci) d 3
AGENT /OWNER DATE
ADDRESS I -DI; Powei.S Ins_\ , tAr - -- k - , -- --Lin LIE
TELEPHONE #