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~ CITY OF OSHKOSH :;:;¿ LJ-/..2 L/
CITY OF OSHKOSH PERMIT - APPLICATION AND RECORD
TYPE: BLDG 0 HTG 0 ELEC ~ PLBG 0 SIGN 0 ZONING - FLeOD PLAIN - HEIGHT-
....................................................................
DESIGNER
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PLAN NO.
ADDRESS
OWNER
USE:NATURE OF WORK
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BUILDING CONTRACTOR
SIze
Sq. Ft.
{# Rooms
# Slori~s
H¿ight
Foundation
Class of Const.
Occupancy Permit
HEATING CONTRACTOR
Heat 0 AiC 0 Ven~ 0 FueVSystem
Heat Loss
STU'S
ELECTRIC CONTRACTOR
Electric Servo New ~ Change 0 Temp 0 Type}'-W Volts {7-.. 'tOAmps /ðO
Fixtures C><-.---. Switches ~ Receptacles ~ Circuits /:>(
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PLUMBING CONTRACTOR
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_Lav
_WH
_Sh
_Disp
_DW
_SP
_WSoft
_OF
_CSasin
- San. Sewer
_WC
_FOr
_LTub
_Ur
- Storm S~wer
_Water
_Sink
Other
- Eject
_S5
ate
Park Dedication S
FinaVO.P. ~ ~{g-~b
ISSUED S
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (M t? f/~
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ADDRESS
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