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CITY OF OSHKOSH N! 42235
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / r 8 ,-/o�. -tom- -- PLAN NO.
OWNER --CZ /
o -1
DESIGNER
USE /NATURE OF WORK —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 _L WH ___L_ Disp _ WSoft _ CBasin G/G
�L av _ Sh _. DW _ DF _ San. Sewer
-Y WC / FDr SP _ Ur _ Storm Sewer
L. Sink i' LTub Eject SS _ Water
Other — 1 Ga � , f aerii
FEES: Valuation $ •S0 - Q d Permit Fee Paid $ -s ^ O a Park Dedication $
ISSUED BY____ Date "`f 7
S5,e Final /O.P. D ' 30 ' 9Y
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
1LUM ING PERMIT APPLICATION
ADDRESS( 2-? /i6n.�yS DATE /i' S'� P�R� �z,3S_"
OWNER .
PLUMBER . • S
NATURE OF WORE LLLY ` - / ' / /
NEW RELAY REPAIR / INTERIOR
SAN SEW #
S ZQRIS SEW , 2- Bathtub //
Sump Pu
Lavatory/ / Ejector
INSPECTION DATE INSPECT 7- Toilet // Water Softener
ION DATE ( Kit. Sink/
Drinkin g Fountain
/ / / /�
Sink(other) Urinal
V/ f ( / t ' f W terheater / Slop Sink
// Showe Grease Trap
Floor Drain / Local Waste
/ Laundry Tub, Site Drain
/3b/ / Dis•osal 1 / Laundry Standpipe/
/ Dish asher Cat •.:r �- . 1
' � /12_'/
** 'fi notes on the reverse sidel
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