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CITY OF OSHKOSH - 42280
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG )4r SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS S G / / PLAN NO.
OWNER Zee- r---
DESIGNER ,
USE/NATURE OF WORK , II — / --t — �
h ._
/
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 k 0_,..---Z.._
- BT WH _ Disp _ WSoft _ CBasin /
- Lay _ Sh _ DW _ DF / San. Sewer ' fv
— WC _ FDr _ SP — Ur — Storm Sewer
- Sink _ LTub _ Eject — SS — Water
Other
r
30 /
FEES: Valuation $ Permit Fee Paid $ Park Dedication $ •
ISSUED BY Date rY j 5- I' Final /O. P. 1 0 "CACY"
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE _A --?j'/D A giE ------
(0-z t--9 4-
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
11 LING PERMIT APPLICATION - ADDRESS' .......,&_, DATE to 2 PERMIT# $‘--2.-...2--.9---6
OWNER .
NATURE OF WORK / _ / / / y /
-Y- ...
NEW RELAY REPAIR _ I NTE '' OR
SAI SEW , 6 -eJ� - # #
WATER Bathtub Sump Pump
4 A. Lavato Ejector
Toilet Water Softener
; NSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
pla........d Sink(other) urinal
p/, Waterheater Slop Sink
Shower Grease Trav
•,. ' Floor Drain Local Waste
/ L.-- .,---0-1-e- l p �; f� „ , ■ Laundry Tub Site Drain
f / Disposal Laundry Standpipe
Catch Basin
** Violation notes on the reverse side]