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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
05962
TYPE: BLDG D HTG D ELEC ~PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS /cf??S- Oc:.A-~~ - ~ '
OWNER ~ /c;x:~~.
PLAN NO.
DESIGNER
~~.
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
New [g-"' Change D Temp D Type _ Volts _ Amps ~
i./'"Switches Y Receptacles I./' Circuits e--
~?
~
Electric Servo
Fixtures
~
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
Cf..!::----.
~CJO Permit Fee Paid $
/
V
-- ~
:? t7 Park Dedication $
/tJ -- 2tJ .- F 7' Final/O.P.. / - t(- tiff'
ISSUED BY
Date
In the performance of this work I agree to perform all
ork pursuant to rules governing the described construction.
SIGNATURE
/,Il-;<tJ-Y?
DATE
ADDRESS
TELEPHONE #
SIGNS
INSP. ROUGHIN - 'l-
EST. COST /~d~
REMARKS
ELEC. CONTR.
OWNER
ADDRESS
NATURE O:E' WORK
ELEC. SERVo
DESC. TYPE
FIX'S Cxl
APPLIANCES
TEMP.
AMPS eJ
CIRC' S J>(
SERVICE
PERMIT FEE