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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
05958
TYPE: BLDG D HTG D ELEC<< PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
- - -- -- - -- - -- - - - - -- - - - - - - -- - ----
ADDRESS
PLAN NO.
DESIGNER
USE/NATURE OF WORK
~(2A/ ~
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
ELECTRIC CONTRACTOR
Electric Servo New ~ Change ~Tem
Fixtures c..---. Switches ----
Heat Loss
BTU'S
Type _ Volts _ Amps 7C>O
Receptacles --- Circuits
/JP-
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
I
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t:7~ Permit Fee Paid $ D (/
Date It :2tl-87
Park Dedication $
Final/O.P. 1;2 -c2 '1 - "17
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
$~
( AGENT/OWNER
I vt?<~ -37
DATE
ADDRESS
TELEPHONE #
OWNER
ELEC. CONTR.
ADDRESS
NATURE OF WORK
ELEC. SERVo
DESC. 't'yp
FIX'S
APPLIANCES
TEMP.
AMPS .::L cJ c;J
CIRe' S ~
SIGNS
INSP. ROUGHIN('!l
EST. COST
REMARKS