HomeMy WebLinkAbout0023893-Plumbing (abandon laterals) CITY OF OSHKOSH N° 23893
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG g' SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS °2 c / -tom, . - PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK , 'c - 4 a -e-- ‘ — `t - 1 i =_ - -
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
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation $ �` d Permit Fee Paid $ �� ` / Park Dedication $
ISSUED BY Date / Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ;6
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PLUMBING PERMIT APPLICATION
ADDRESS ,,,G� - vyz,a DATE //-2-1C7 OWNER :74"
-t -.-ems. PE RMI T�� �.3 x`93
.��� PLUMBER
NATURE OF WORK �n,
NEW' RELAY REPAIR INTERI
SAN SEW
WATER # # STORM SEW Bathtub Catch Basin
Lavatory Grease Trap
Toilet Sump Pump
INSPECTIO DATE INSPECTION DATE Kit. Sink
Local Waste
.) G Sink(other) Site Drain
Shower Laundry Stand Pip -
Floor Drain Laundry Tray
Disposal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
.Urinals Future outlets
1** Violation notes on the reverse side!