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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N~ ~. 47971
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR a~.4~~r-
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH
_Lav
_Sh
_FDr
_ L Tub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_WC
_Ur
_ San. Sewer
_ Storm Sewer
_ Water
_Sink
Other
_ Eject
_SS
FEES: Valuation $
ISSUED BY
Permit Fee Paid $
Date
3s~o-o
lo4i? ) r
I '
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
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #