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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
01087
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OWNER .
DESIGNER
USE/NATURE OF WORK
~~ch
/
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
~-<-,,-y
Temp~' Type~Voltl?12 J,gps ~
Receptacles C;'cuits ~.
Electric Servo
New D Change D
Switches
Fixtures
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_ San. Sewer
_ Storm Sewer
_Lav
_WC
_FDr
_ L Tub
_Ur
_Sink
Other
_ Eject
_SS
_ Water
".
'_. 0 0 (/"/
_ FEES, vaJuat;o~_ _ Pe'm;t Fee P,"d $ <{ ~ _
ISSUED BY ..~ Date Y :z F" Z 0
Park Dedication $
Final/O.P. 7-/ t+--2fh
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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GE ER '
SIGNATURE
DATE
ADDRESS
TELEPHONE #
PERMIT' NO. () / 6 ~ 1 . APPL. DATE 7 -;7 -?~
ELEC. CONTR. (~7~~
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NATURE OF 'WORK
SIGNS
INSP. ROUGHIN
EST. COST ~
REMARKS
TEMP.
AMP
ct~CIS ...
ELEC. SERVo NEW
DESC. TYPE LA../ ,.--
FIX'S
APPLIANCES