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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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32101
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DESIGNER
90{~
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PLAN NO.
ADDRESS
OWNER
USE/NATURE OF WORK
!/1J¡;-f
BUILDING CONTRACTOR
Size
Foundation
Sq. F!.
# Rooms
# Stories
Height
Occupancy Permit
Class of Cons!.
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuei/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type- Voits- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT -ÍWH
.5:~
_Lav
_Sh
_FDr
_Disp _WSoft - CBasin
_DW _DF - San. Sewer
-SP _Ur _Storm Sewer
_Eject -SS _Water
~
_WC
_Sink
Other
_LTub
FEES: Valuation $
ISSUED BY
.s-3S-.Öð
JP-
/
/'0 - () 0 Y'
Permit Fee Paid $ I
Date /2-/ l-- ;1.-/'7 L.
( /
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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DATE
ADDRESS
TELEPHONE.