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CITY OF OSHKOSH N2 33372
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / Y ' PLAN NO.
OWNER / i e i fp e r__ e _ e _
DESIGNER /
USE /NATURE OF WORK / h - c
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 __""1,01/H Disp WSoft _ CBasin 9
Lav _ Sh _ DW DF San. Sewer
c
WC 2-- FDr 2 Ur Storm Sewer
_ LTub Eject SS Water
Other .2. - /9C 1.-;.a.---..-/-7_0.
o FEES: Valuation $ Keno o ' Permit Fee Paid $ ® Park Dedication $
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ISSUED BY Date �� /�
Final /O.P. ��
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE - -NE 4 ,�/ -�". 9�
/, AGENT /OWNER .Or / DATE
ADDRESS _ - . v _, ,--r-/ c). -' ZCZ_S
TELEPHONE #
y/C
PLYING PERMIT APPLICATION
ADDRESS.
/ o7 / � DAIE 7> - 3c - � PERNZT# 3 3 �
MEER ; D- K. 47- -- - --- - - - -- - ,/ PLUMBER . i -
NATDaE OP WORE , //V- -1).---ti-c7. - s--4-1-42.--e--2- A
RELAY REPAIR • 4 - 44 0R
;AN SEW # #
WAR Bathtub -v Sump Puna /
K• ,■- 1 ;. Lava • 1 E ector
Toilet / Water Softener
INSPECTION DATE TOSPECTION DATE Lit. Sink
Drinking Fountain
Sink(other Drinal
lit (- V - 3D , v Waterheater ® Slop Sink
q ,Shower Grease Tran
1 �// Floor Drain / Waste
Laundry Tub Site Drain
9/)- /O' SO ail? Disposal 9-- Laundry Standpipe )/
,Dishwasher Catch Basin
1 0 A q/ -1 /1/3 , j 3'' e 11„,.. - L. -� �- c's :%
,,, , � ,,
„--zi.pk, L) ,,,i , _,,,) f),, N Violation notes on t-h reverse side ( 'NW" - /AMP •,■=.,�
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