HomeMy WebLinkAbout0039291-Plumbing (laterals) �U
N°_ 39291
/� CITY OF OSHKOSH
`' PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS � � -�-�-�-�� PLAN NO.
OWNER ��� �(,�{�f �[.��
DESIGNER
USE/NATURE OF WORK /`�dl�(c{�` ':�Y� i Yl !�l�'y(,(/'��
1 � � �a.�
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_T/.t.�f�'���-Q�I'�
—BT _WH _Disp —WSoft —CBasin �C�
�Lav �Sh _DW _DF —San. Sewer
1 WC �Fflr SP —Ur —Storm Sewer
\Sink �LTub Eject —SS —Water
Other � �
.� . o�
v
FEES: Valuation $ • �V Permit Fee Paid $ � Park Dedication $
ISSUED BY Date 5�y Final/O.P. �"� �/� '
tn the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE `�'�
AGENT/OWNER DA E
ADDRESS
TELEPHONE# �
♦ X-�c �
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PL�IDII� PE�II'T APPLZCs1ZI0N
�IDDRESS 3 7 L r'"«-� DATE `� .�° � PER�?# �����
OWNER � PLDlID �
NATQEt�: OF WCRF S�G'(/� �12-
NEFT RELAY BEPAIR IN�RIOH
AN SEtiJ # #
�1ATER Bathtub Sum Pu
Lavsto E'ector
Toilet Water Softener
0[Q DA1E INSPECTIQN DA1E Ri.t• Siak Drinkin Fountain
Siak(other
� / n ' � W te he ter Slo Sink
�� j� ( � e se Tra
_/ � �° � � � Floor Drain Local Waste
Laundry Tu Site Drain
Dis osal Laundr Stand i e
Dishwasher Catch Basin
** Vielaticn n�t•_� on the rever�e side