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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD N2 31658
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG$ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS " % . ,6 G I PLAN NO.
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DESIGNER ;.l
USE /NATURE OF WORK
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BUILDING CONTRACTOR
Size 1 Sq. Ft. rI
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k # Rooms # Stories Fl Height
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Foundation Class of Const. Occupancy Permit
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HEATING CONTRACTOR k' 6
Heat ❑ AIC ❑ Vent ❑ Fuel /System h4 Heat Loss` BTU'S
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ELECTRIC CONTRACTOR . '
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Electric Serv. New El Change ❑ Temp El Type Volts Amps
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Fixtures Switches kl Receptacles Circuits II
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PLUMBING CONTRACTOR 6,.. I!
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BT I WH Disp WSoft Basin
- Lav Sh DW DF San. Sewer
WC FDr II SP Ur I� K C
Storm Sewer
- Sink LTub Eject SS _Water
Other
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FEES: Valuation; $ Permit Fee Paid $ Park Dedication $
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ISSUED BY Date / / //,' 2 — Final /O.P.
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE • / ���� ��
(((( AGENT /OWNER 111 ATE
ADDRESS l� j� 4 "c. )� 2 -Lriti
TELEPHONE #
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,-B o O PL1fl ING PERMIT APPLICATIO
ADDRESS � �r � ` DATE . 7 / -/ Z 11 PERMIT# . S g
OWNER 61,-,..— l e -.3, ( ' A 0 1- .15ic. MISER
z��-4- . -1/-3 NATDRE OF WORE — ( ,-., 1 r
NEW RELAY REPAIR. INTERIOR
SAN SEW # it #
WATER ,a Bathtub __ 6 Sump Pump
IRM SEW f ) (/C.- . Lavatory ii _Ejector
Toilet s Water Softener
INSPECTION 1 DATE INSPECTION 1 DATE Kit. Sink i' Drinking Fountain
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Sink(other) ii , Urinal t `� . j Waterheater we Slop Sink
4" - S hower i! Grease Trap
;` ; ;> Floor Drain 11 Local Waste
,. , Laundry Tub ; Site Drain
4 ' ,Disposal i! Laundry Standpipe
2��3� , Dishwasher s Catch Basin
** Violation notes on the reverse side]
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