HomeMy WebLinkAbout0002503-Plumbing (kitchen) � CITY OF OSHKOSH No 02503
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`' PERMIT — APPLICATION AND RECORD -
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG� SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ��� S _r �-,a� / PLAN NO.
OW N ER ��gd�_-__7C�( 6�1 /�a-�
DESIGNER
USE/NATURE OF WORK /�7�i12-co�g /_"�� �T�
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
Fi�ures Switches Receptacles Circuits
PLUMBING CONTRACTOR ��P��
BT WH Disp —WSoft —CBasin
—Lav Sh —DW —DF San. Sewer
—WC FDr —SP —Ur Storm Sewer
�Sink LTub Eject —SS —Water
Other
r-r--,� �-rrri
FEES: Valuation $ Permit Fee Paid $ Park Dedication $
ISSUED BY Date � Final/O.P. �7�R7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
A ENT/OWNER DATE
ADDRESS
TELEPHONE#
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STATE OF WISC@TSIN )
) SS
WINNEBAGO COUN'1'Y )
��cz s� O /lJ rt'O � � / �•Z -�G/I d 6/ .
Name - Address
be1Ag first duly sworn on oath deposes and sa ys that he is not
a licensed plumber, and that he has applied for a plumbing
permit to the Plumbing Inspecto r of the City of Oshkosh, to do
plua�bing work in a home owned and occupied by him, or a home
that is being constructed that is owned by him, and which will
be occupied by him as his home when completed. That he is not
buildinq said home� �or the purpose of sa1e. .
This affidavit is a�ade for the purpose of complying with
the provisions of the plumbing code of the City of Oshkoah and
the State of Wiaconsin, which provides that all plumbing work
muat be done by a licensed plumber except that the plumbing wor�
may be done by one who owss and occvpies his own hocne providing
the installation compl.ies with the plvmbing code of the City of
Oshkoah and the State of Wiscons in.
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This affiant understands that the Plumbing wo rk authorized
by the permit applied for, me�st be done only by this affiant and
that he cannot employ others who are not licensed plumbers to
assist with the work.
Dated this 7 day of �A � , . 19_a��.
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Subscribed and swern to before me � `�
1 ;.,..�.,�,,,�„�,��_ _ =,�..,.
this ;`X�L day of �1��� _, 19 � � . '
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,� o US�.�Gtiti- : �
Nota Public, Winnebago County, Wisconsin _�
My Commission Expires: - - �1 - � �
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