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LJ II
Ng- - 43659
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
TYPE:
BLDG D HTG D ELEC D PLBG):8( SIGN D ZONING - FLOOD PLAIN - HEIGHT-
-..... - -..... - -..... _.... - -.......... - - -... - -... - _. - -.. - -. - - - - - - _...
ADDREssì l~tß Och l}-t JYì
OWNER ,~ ::f¡. ÌYì-tt
PLAN NO.
DESIGNER
USE/NATURE OF WORK . ..lDf\ -ti '( ,XI Q (\ \tr
BUILDING CONTRACTOR
Size Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type- Volts- Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR ZD.ffií1\ffiìS
_BT -Ì-WH _Disp
_DW
_Lav _Sh
_WC _FDr
_Sink - LTub
Other
FEES: Valuation $ 4Cf),CD
ISSUED BY
_WSoft
_DF
- CBasin
- San. Sewer
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-SP
- Eject
_Ur
- Storm Sewer
_Water
_SS
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/
Permit Fee Paid $ If). DD A'
Date é) ')
/
Park Dedication $
FinaVO.P.
In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNA T:;~~~'
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OATE
ADDRESS
TELEPHONE #