HomeMy WebLinkAbout0016614-Plumbing (interior) 411.-) CITY OF OSHKOSH N° 16614
- PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /: /7/(Into-r- PLAN NO.
OWNER j✓+'l '3 i1 ��j`C C...
DESIGNER `
USE /NATURE OF WORK G. .Lryf? g1..e //. /-22ei
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 ___ /V
BT WH Disp WSoft CBasin
4 Lav Sh DW DF San. Sewer
4 _ WC 4_ FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
/ aft ✓
FEES: Valuation $ ( Permit Fee Paid $ �Q Park Dedication $
ISSUED BY Date / -5-. Final /O.P. / - / 0
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 #
/ � // PLUMBING PERMIT APPLICATION /
ADDRESS /`/Y 3 / �n� ) /� /1' -4Y1 l�d'Z DATE / - ,,P PERMIT # ! (‘/
OWNER /7 /vrf j e-e / PLUMBER 4 (' ��4.x. -r
NATURE OF WORK �/e /'A,/S C
NEW RELAY REPAIR INTERIOR
SAN SEW 1 # #
WATER Bathtub Catch Basin
STORM SEW / Lavatory Grease Trap
( Toilet Sump Pump
INSPECTION DATE INSPECTION DATE Kit Sink Local Waste
Sink(other) Site Drain
, Shower Laundry Stand pipe
/*/f Pq Floor Drain Laundry Tray
( Disposal Wat. Softner
Dishwasher D. Fountain
/ Water Heater Ejector'
I Urinals Future outlets
J ** Violation notes on reverse side