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� CITY OF OSHKOSH N° 26746
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG � SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS S�� � • �/ /7��-� PLAN NO.
OWNER � �
DESIGNER
USE/NATURE OF WORK �-
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 - '�-�� �
�.1
:
—BT —WH Disp —WSoft CBasin
—Lav Sh DW DF San. Sewer
. WC —FDr _SP Ur Storm Sewer
Sink _LTub —Eject —SS —Water
Other
FEES: Valuation $ �� ° ° d Permit Fee Paid $ � ° ' � `� Park Dedication $
ISSUED BY � Date � � � '�� � �� Final/O.P. �a`� � - y� �
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Z
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
PLUI�ING PERMIT APPLIC�ITION
ADDRESS ��/ G•-i . ,ti'�--r� DATE r ,� -- � 6 ^r'/ PERMIT# -�� � �-�
0'WNER ' �' J PLIIrIDER .��r P �,.J--
NATURE OF WORK / ��, .�-r �-� ° ��,-�,�_
NE[1 LAY REPAIR INTERIOR
SAN SEW # �
WATER Bathtub Catch Basia
Lavato Grease Trao
Toilet � g p �
INSPECTION DATE INSPECTION DA1E Rit. Sink Local Waste
� � °� Sink(other Site Drain
0 1 _°� / ��er Laundrq Stand Pipe ,
loor Drain Laund Tr .
Dis osal Wat. Softner
Dishwasher D. Fouatain
Water Heater E�ector
Future outlets
** V" a ' o on the reverse side