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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
21887
TYPE: BLDG D HTG Qo ELEC D PLBG D SIGN D ZONING - FLOOD PLAIN- HEIGHT-
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ADDRESS Itl ;¡- / LV Jf ~ . J 4- PLAN NO.
OWNER Ìh L!J r' n """-
,
DESIGNER
USE/NATURE OF WORK
~lace
-Furl?t?re
5'-F;
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
~ HEATING CONTRACTOR p/Qn/¥p,,:/ f-~hJ
L Heat Ií'!' NC D Vent D Fuel/System .
Heat Loss p>e/-S- T
BTU'S ".~ ~
ELECTRIC CONTRACTOR
Eiectric Servo
New D Change D Temp D
Type - Voits - Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_Disp
_DW
_WSoft
_DF
-CBasin
_Lav
- San. Sewer
_WC
_FDr
_LTub
_SP
_Ur
- Storm Sewer
_Sink
Other
_Eject
_SS
_Water
FEES: Valuation $ $.C
ISSUED BY
Permit Fee Paid $
Date
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~
. I~I/l/t¡t'
Park Dedication $
Finai/O.P.
In the performance of this work I agree to perform ail work pursuant to ruies governing the described construction.
SIGNATURE
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TELEPHONE #
ADDRESS