HomeMy WebLinkAbout0043530-Plumbing (laterals)n CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2 43530
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms # Stories
Class of Const.
Height,
Occupancy Permit
HEF, JG 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_ �--
BT _ WH — Disp — WSOft — CBasin �-
Lav _ Sh
— DW — DF /San. Sewer--
SP U r
— WC — FDr — — r � Storm Sewer � � y
1
— Sink — LTub — Eject __SS Water �� c
Other
FEES: Valuation $ S ' � Permit Fee Paid $ 3 0 '
Park Dedication $
ISSUED BY `'r Date �' Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
`'% a/ AGENT'OWNER / ///
1 & '. / /S� �, y ,� DATE
ADDRESS �� 5 = 6'V5C�.
TELEPHONE #