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. CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
06684
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ADDRESS
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PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU.S
ELECTRIC CONTRACTOR
Electric Serv.
New 0 Change 0 Temp 0
Type- Volts- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
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_BT
_WH
-Sh
_Disp
_DW
_WSoft
_DF
_WC
_FDr
- LTub
-SP
_Ur
- CBasin
...1.- San. sewer~f?v,--
L Storm Sewer ~C>I/r
...L.- Water / tr '"'ff'e---.
_Lav
_Sink
Other
_Eject
_SS
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FEES: Valuation $ ð¿P~
ISSUED BY ~.r.
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Date Þ9-,k7
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 ~
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AGENT/OWNER
DATE
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ADDRESS
TELEPHONE #
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