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CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
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TYPE: BLDG 0 HTG 0 ELEC 0 PLBG].(.. SiGN 0 ZONING
FLCOD PLAIN
HEIGHT
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OWNER
DESIGNER
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USE'NA TURE OF WORK
BUILDING CONTRACTOR
S:ze
Sq. Ft
# Rooms
# S!ori~s
Height
Foundation
Class of Const.
Cccupancy Permit
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 {~I (~~ s
LOT J- WH L Disp
d... Lav .../- Sh L OW
,z wc -I- FOr L SP
-I- Sink - L Tub Eject
Other 1- /-?~--<--70 S~~;P~
_ WSoft
_ CBasin
_OF
_ San. Sewer
_Ur
_ Storm Sewer
_ Water
_SS
FEES: valuahon~~
ISSUED BY, .
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3~r
Permit Fee Paid $ .
Date ~/3 4
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Park Dedication $
Final/O.P. 1 '00. 2'f..
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
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OATE
ADDRESS
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