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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02232
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG.f5-- SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
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PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type_ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
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_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer </ e'( ;4'~
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water J 4 C ~cr'-f";.--
Other
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FEES: Valuation $ .. . /
ISSUED BY .::r&-/
/
/
V
Pe'mil Fee Pa;d $ ~k
Date /..2-3
Park Dedication $
Final/OP. / -;} :z ~t 7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
DATE
ADDRESS
. TELEPHONE #