HomeMy WebLinkAbout0009987-Plumbing (remodel kitchen & bathroom) � CITY OF OSHKOSH No 09987
� �' PERMIT — APPLICATION AND RECORD
`+ TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS �� /�i�� , ��� PLAN NO.
OWNER �1/LL ��LL�/1���d�I.--/��1-�`
DESIGNER
USE/NATURE OF WORK r
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 ���,
�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 $ Park Dedication $
ISSUED BY Date Final/O.P.
In the performance of this w agree to perform ork pursuant to rules governing the described construction.
SIG ' �
.. AGENT/OWNER DATE �
ADDRESS
TELEPHONE;M
•
STATE OF WZSCt7NSIN )
) SS
WINNEBAGO COUNTY )
/ � ^ �`L
�x/ lt� .rr/2 , o�.S Gr�P 5 � �S
Name • Address
being first duly sworn on oath depoaea and says that he is not
a Ilcensed plumber, and thet he has applied for a plumbing
permit to the Plumbing Inspector of the City of Oshkosh, to do
plumbing wvrk in a home owned and occupied by him, or a home
that 19 beinq constructed that is owned by him, and which will
be occupied by him as his home when completed. That he is not
building said home for the purpoae of sale.
This agfidavit is anade for the purpoae of cocnplying with
the provisions of the plumbing code of the City of Oshkosh and
the State of Wisconsin, which provides that all plumbing work
muat be done by a licensed plucnber except that the plumbing work
may be done by one who awna and occupies his own home providing
the insta].lation complies with the plvmbing code� of the City of
Oshkosh and the State of Wisconsin.
This affiant understanda that the Plumbing wo rk authorized
by the petmit applied gor, must be done only by this affiant and
that he cannot employ others who are not licensed plumbera to
assist with the w�ork.
Dat ed this �� da y of L . 1 U .
Subacribed and swcrn to before me
this a�� day o , 19 $ ' .
Notary p lic, Winnebago County, Wisconain
My Commisaion Expires: