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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
04180
TYPE:
BLDG D HTG D ELEC ~LBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
.. --... --.......... --........... --...... --............................. --............ -- --"'''' --...-... --.. ---..-......... --...... ----
OWNER
/~C5 ~~CVLa
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PLAN NO.
ADDRESS
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
Electric Servo New [B'Change D
Fixtures ,y- Switches
~~.
r
j
Amps2~
l-- tfQ t
Temp D Type _ Volts_
V'" Receptacles z- Circuits
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
ISSUED BY
Permit Fee Paid $
Date
.50 ~
tt-I/-87
Park Dedication $
FEES: Valuation
Final/O.P.
7~/1J-~1
In the performance of this work I agree to
orm all work pursuant to rules governing the described construction.
SIGNATURE
DATE
ADDRESS
TELEPHONE #
PERMIT NO. 0 1 (. s (! APPL. DATE 1/ -) cJ - g 7
ELEC. CONTR. ~~ '
OWNER ~...,.~-
I <TJo- (/~/
~ I-V--~
ADDRESS
NATURE OF WORt<
SIGNS
INSP. ROUGHIN
EXT. COST J
REMARKS
CHANGE
VOLTS I
RECEPT'
TEMP.
AMPS ~ClO
CIRC' S t><
ELEC. SERVo
DESC. TYPE
FIX.IS ..' P<..
APPLIANCES
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