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CITY OF OSHKOSH N2 33868
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG'j SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / � � 9 6 / �� PLAN NO
OWNER
CS - � / d
DESIGNER , /
USE /NATURE OF WORK S / � - 6 '
/V -
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 --- 71..ge---7 52-- E ,-7_,___.,,,_ -
BT WH Disp WSoft CBasin
- Lav Sh DW DF ( San. Sewer cz C
WC FDr SP Ur -f— Storm Sewer P P v C
- Sink LTub Eject SS Water
Other
3 d ✓
FEES: Valuation $ JC Lit-, . Permit Fee Paid $ Park Dedication $
ISSUED BY Date -1 - 3 Final /O.P. P 93
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE /9'<r' S.:'/'7 , 3
�,+ !� 6 AGENT /OWNER DATE
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ADDRESS • `- -��(! .� / - / Live-7, 4 e L
TELEPHONE #
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- IJNG PERMIT APPLICATION
ADDRESS ,- g - I/ / DATE ss7t , 9 PERIM* . 3 3 8 6 Air i
OWNER . - e ; -4; -tif."
,1oTORE of WORE , /1/S R -
NEW RELAY REPAIR c OR
SEW ' hJ C- # #
WATER Bathtub Sump PumQ
r• c ,. A{, IMI Lavaca E' ector
Toilet Water Softener
INSPE ON DATE INSPECTION DATE Kit. Sink Drinking Fountain
Sink(other) Urinal
3 ni -57---S -57---S / q 3 Waterheater Slop Sink
... e -se T a•
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
** Violation notes on the reverse side]