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N2 - 43188
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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ADDRESS
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New D Change 0 Temp D
Type - Volts - Amps -
Fixtures
Switches
Receptacles
Circuits
~~~
PLUMBING CONTRACTO¡R
_BT _WH _Disp
_WSoft
- CBasin
c
_Lav
_Sh
_FOr
_OW
-SP
_OF
- San. Sewer
_WC
_Sink
Other
_LTub
- Eject
_Ur
_SS
- Storm Sewer
_Water
FEES; Valuation $ '3:, ,,--t) - ð è
ISSUED BY ~-----------
Permit Fee Paid $
Date
/1
./
....0 - C Ö Park Dedication $
{~/êO/7",V Final/OP
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
JJ1~L ~ ~
AGE 'OWNER
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ADDRESS
TELEPHONE.