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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
00473
TYPE: BLDG D HTG D ELEC f2( PLBG D SIGN D ZONING FLOOD PLAIN HEIGHT
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OWNER
DESIGNER
USE/NATURE OF WORK
w~a.t:' -
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
&L.
f. Ac
Electric Servo
New D Change D Temp 0
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY
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Permit Fee Paid $
Date
J
/ ..2- ~ y'
7-11 r~.h
Park Dedication $
Final/O.P. 7 -~ II~- 8" h
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATU~/
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AGENT/OWNER
DATE
ADDRESS ~/.:;l6 ttI~;f
TELEPHONE #