HomeMy WebLinkAbout0024065-Plumbing (laterals) CITY OF OSHKOSH N° 24065
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS , KZ- 0
D
PLAN NO.
OWNER 6 • Y
DESIGNER
USE /NATURE OF WORK /e-� -� S ( O /' /
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 r . - /
BT WH Disp WSoft CBasin
Lav Sh DW DF / San. Sewer V, V C
WC FDr SP Ur / Storm Sewer r 1 I C
Sink LTub Eject SS 1 Water l /1
Other
FEES: Valuation $ I / 20 ° . o d Permit Fee Paid $ 3 o • O d Park Dedication $
W
ISSUED BY Date 7- 2 '9
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
tea— ,,'
SIGNATURE �j
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
•
c � r ► 'LURING PERMIT APPLICATION
ADDRESS T ° .4 r , ' 1 Q,.✓ DATE . C l°" — �� PERMIT# ' Kb
I
OWNER —i•- � � ` { _i PLUMBER 41.41.0 c4-4,�Q
NATURE OF We / / e (dy. .Rit ; 4 1 '94 a' , 41( °1 A cr R././
NEW RELAY REPAIR INTERIOR
�t
SAN SEW / e 'JC
WATER I Cu- Bathtub Catch Basin
STORM SEW 5‘ tc> c Lavatory Grease Trap
Toilet t Sump Pump
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
C w/� .2 g Sink(other) Site Drain
Shower Laundry Stand Pipe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
Urinals Future outlets
I** Violation notes on the reverse side]