HomeMy WebLinkAbout0019537-Plumbing (cap sewer for raze) ;`� � CITY OF OSHKOSH N° 19537
� `' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG�` SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS t 3� �o����� PLAN NO.
OWNER -
DESIGNER
USE/NATURE OF WORK�c?,S`��„6,�� � �'C��-r ./J�'iP��'7i��/
BUILDING CON�"RACTOR
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
PWMBING CONTRACTOR /� ��E _
—BT _WH —Disp —WSoft _CBasin
�—Lav —Sh —DW —DF _San. Sewer
,
—WC _FDr —SP —Ur Storm Sewer
—Sink _LTub —Eject —SS —Water
Other
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FEES: Valuation $ ��� Permit Fee Paid $ �G°D 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 �
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
PLiJMBING PERMIT APPLICATION
ADDRESS .3 S Gc� • 7 � DATE 7 � o �`��3 ;
PE RMI T�k �
��R D f � � PLU1��R "
NATURE OF WORK �
NEW R LAY REPAIR INTERIOR
SAN SEW �k �k
WATER Bathtub Catch Basin
� S� Lavator Grease Trap
Toilet Sum Pum
INSPECTION DATE INSPECTION DATE Kit. Sink Local Waste
Sink(other) Site Drain
�� q � , Shower Laundry Stand Pipe
eC�W�O ��o�-d��� Floor Drain Laundr Tra
Dis osal Wat. Softner
Dishwasher D. Fountain
Water Heater Ejector
rinals Future outlets
** Violation notes on the reverse side '