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39255
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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Ciass of Const.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
Heat Loss
BTU.S
ELECTRIC CONTRACTOR
Eiectric Servo New 0 Change 0 Temp 0
Type- Volts- Amps-
~ Fixtures
Switches
Receptacies
Circuits
PLUMBING CONTRACTOR
~T -L WH -.1 Disp
~ Lav - Sh ..:L DW
Lwc -.LFDr ~SP
-LSink LLTub ~Eject -
Other I ~ tf-C(¡J ~ r r
~ ...4'~
/'4
7~soft
_DF
- CBasin
#./
_Ur
- San. Sewer
- Storm Sewer
_SS
_Water
FEES: Valuation $
yt~;/'O Ò
I
./ yçD G /
Permit Fee Paid $ b
Date 7' ;:/ ~y
Park Dedication $
Final/O.P. 3 "-10 . ") ,¡
ISSUED BY
In the performance of this work I agree to perform ali work pursuant to ruies governing the described construction.
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f AGENT/OWNER DATE
ADDRESS
TELEPHONE #
ÿ/d
NATmŒ
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c1
SAN SEW
WATER
#
INSPECTION
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tI ç 3/7
F
DATE
INSPECTION
Sum Pu
Ejector
Water Softener
Drinkin Fountain
- Violation note!! on the n!ve1:'se sideJ