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N2- - 43223
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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ADDRESS 527 f,1I ¥P-4~
OWNER ß ~ 9~
,
PLAN NO.
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft.
Foundation
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New ~Change D
Fixtures Switches
Volts 7(/ AmpsZ-.t>
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH
_Disp
_WSoft
- CBesin
- San. Sewer
_Lav _Sh
_WC .è.- FDr
_Sink _LTub
_DW
_SP
_DF
_Ur
- Storm Sewer
_Water
- Eject
-_SS
Other
/
~ ~ j
FEES: Valuation $ JO <7. 0 Ð Permit Fee Paid $ _0. <> "
ISSUED BY ~/ j?d",,1'A~ Date I~ß .1"""-
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
DATE
ADDRESS
TELEPHONE.