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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02683
TYPE: BLDG D HTG D ELEC ~ PLBG D SIGN D ZONING . FLOOD PLAIN HEIGHT
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OWNER c~.. ~ .
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heqt D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
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Electric Servo
New D Change--EJ\ Temp D Type _ Volts _ Amps /d
Switches Receptacles Circuits
tJ;Q (
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
Permit Fee Paid $ Z()~ Park Dedication $
Date / - ?-;J-- ??7 Final/O.P. J J- .--/6 - y~
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
1?~
AGENT/OWNER
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DATE
ADDRESS
TELEPHONE #
OWNER
. APPL..
PERMIT NO. c/ ? (; K J
ELEC. CONTR.
ADDRESS
NA'1"URE.OF WORK
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cHANGE
~<..<.--- VOLTS LO
RECEPT'
TEMP.
AMPS (:) c/
CIRCiS
!GNS
!NSl?ROtJGH N
EST. COST. "-I eX!) v
REMARKS