HomeMy WebLinkAbout0021700-Plumbing (laterals) CITY OF OSHKOSH N° 21700
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG1 SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ' Z 0 S PLAN NO.
OWNER '✓
DESIGNER
USE /NATURE OF WORK 4) p-• -.> -S' F 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
ELXTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR if CO-c•-&
BT WH Disp WSoft CBasin fr--
Lav Sh DW DF 1 San. Sewer " n P) C
WC FDr SP Ur 1 Storm Sewer T " I J C'
Sink LTub Eject SS Water /" C.,..,
Other
FEES: Valuation $ 6 06,0 0 O 0 a Permit Fee Paid $ 3 Park Dedication $
ISSUED BY Date /// 7 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE �, � "AeS D 7 ?A S" /- `-
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PLUMBING PERMIT APPLICATION
ADDRESS " Y 9v S DATE ,,�/9'' PERMI # ' 2 / 7°6
OWNER g G D PLUMBER //
NATURE OF WORK �.S ._r_a_ ., �
NEW RELAY REPAIR INTERIOR
SAN SEW I X " A/C , # #
WATER /" Cf-t Bathtub Catch Basin
STOKM SEW V -j ✓C Lavatory Grease Trap
Toilet Sump Pump
INSPECTION DATE INSPECTION DATE Kit Sink Local Waste
U ,,( �r/S/ b Sink(other)
er) Site Drain
J'j Shower Laundry Stand pipe
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
' ,Urinals Future outlets
j ** Violation notes on reverse side