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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N!!-41490
~P_E~ _ _ ~L~~ _~ _ ~T~ _ C? _ ~~E~ _ C? _ ~~B~ Jr' ~I~~ _~ _ ~O_N~N~ _ _ _ _ _ _ _F~~~D_ ~~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _
....
ADDRESS
PLAN NO.
OWNER
DESIGNER
^ ~ U/iY
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
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 ~ S
_BT ~WH _Disp
_ CBasin
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_Lav _Sh _OW _OF
_WC _FOr _SP _Ur
_Sink _ L Tub _ Eject _SS
"-
Other
_ San. Sewer
_ Storm Sewer
_ Water
FEES: Valuation $ V /.s-~ 0 0
ISSUED BY ~~
/
Permit Fee Paid $ /0", d () ,J
Date r- ~.9~
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
r0 . /ci,AHA f~~-'
<./ Y A T/OWNER
DATE
ADDRESS
TELEPHONE #