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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
.30921
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OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms # Stories Height
Class of Canst. Occupancy Permit
Heat Loss BTU'S
HEATING CONTRACTOR
Heat 0 NC 0 Vent 0 Fuel/System
ELECTRIC CONTRACTOR
Electric Servo
Fixtures
New 0 Change 0 Temp 0
Type- Volts- Amps-
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT -L"WH
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_Lav
_Sh
_Disp
_DW
_WSoft
_DF
- CBasin
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_Sink
Other
_FDr
_LTub
_SP
_Ur
- San. Sewer
_Storm Sewer
_WC
- Eject
_SS
_Water
FEES: Valuation $
ISSUED BY
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Permit Fee Paid $
Date
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" - ar De Icatlon
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
ADDRESS
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DATE
SIGNATURE
J-35- (7 '-fì
TELEPHONE #