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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
10783
ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Con st.
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
SCLcf-d.
Fixtures
New 0 Change 9>?Temp 0 Type_
Switches ~ Receptacles
Volts _ Amps_
Circuits V-
<'
~
Electric Servo
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ LTub _ Eject _SS _ Water
Other
ISSUED BY
Permit Fee Paid $ 4, CN ~/
Date,//tJ ~ tb - r y-
Park Dedication $
Final/O.P. / L) ~- 6' -YK
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
-1Q--fo~f~
DATE .
ADDRESS
TELEPHONE #
ELEC. CONTR.
APPL. ~~~/-~-
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PERMIT NO.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW
DESC. TYPE
FIX'S SW'S
APPLIANCES
y(
CHANGE
VOLTS .
RECEPT'S
TEMP.
AMPS
.< CIRC' ~~
SIGNS
INSP. ROUGHIN c>-
EST. COST / .&-Q .
REMARKS '
SERVICE A (, FINAI/t)- /,.d"
PERMIT FEE 'f'::'--- DATE PDJp-.b-M"
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