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CITY OF OSHKOSH
N2 33872
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ir SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS g �i //1 PLAN NO.
OWNER I
DESIGNER
A/C ' //
USE /NATURE OF WORK
/
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 617 EK--e-er--r---
BT WH Disp WSoft CBasin 0
Lav Sh DW DF _L San. Sewer S6 Q J C
WC FDr SP Ur / Storm Sewer Y (T /� U C
Sink LTub Eject SS L Water / �-*_-
Other
p, 0 0 r/
FEES: Valuation $ O O 0 , 0 Permit Fee Paid $ 3 Park Dedication $
ISSUED BY Date �/ l l 9 - � Final /O.P
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE f��-... l`' S- / 1).` -/ j
, AGENT /OWNER ��� DATE
/�
ADDRESS /: C/, / `TC' a ,/ e 4. C i f f C am , : 2 C l V - , f
TELEPHONE #
J�O
II�C R 141'! APPLICATIO
ADDRESS 8 � N
. 1/' / DATE ,s7/ 7 9. PERNIT# 2
/
OWNER , �-- i1 • , -�- 4
NATOSE of WORE d --C / - 0 �411
NEW RELAY =EL= T '
ETE : 'OR
X11()C # #
WATER _ __"'_� Bathtub Sump Puy
Nis . 1A. �1 � Lavat- E' ector
Toilet Water Softener
INSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
��, S� Sink(other) Urinal
/1/0 , N5. �T / °/ Waterheater Slop Sink
41. - e_ e Tr
( /U/ 0 .,1,f-7, ,F1oor Drain Local Waste
kro ^ D Laundry Tub Site Drain
C.a� Disposal Laundry Standpipe
Dishwasher Catch Basin
** Violation notes on the reverse side(