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CITY OF OSHKOSH N2 06245
PERMIT - APPLICATION AND RECORD
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BLDG D HTG D ELECLj PLBG D SIGN D ZONING FLOOD PLAI~ .. HEIGHT ~
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PLAN NO.
ADDRESS
OWNER
DESIGNER
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USE/NATURE OF WORK
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# Rooms # Stories I K. Height 2-0
Class of Const, 8 Occupancy Permit A/o
BUILDING CONTRACTOR
Size Sq. Ft.
Foundation rrr;:('J c k-
--
HEATING CONTRACTOR .
Heat D NC D Vent D Fuel/System
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Heat Loss
BTU'S
ELECTRIC CONTRACTOR r
---- ----.---
Type_ Volts_ Amps_
Fixtures
Electric Servo New D Change D Temp D
Switches
Receptacles
Circuits
----
_BT
PLUMBING CONTRACTOR
_ CBasin
_Lav
_WC
_Sink
Other
_WH
_Sh
_Disp
_OW
_SP
_ WSoft
_OF
_ San. Sewer
_ Storm Sewer
_Ur
_FOr
_LTub
_ Water
_SS
_ Eject
ISSUED BY
aid $ /~ be?
Date /(--0 -25-/"
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Park Dedication $
Final/O.P.
In the performance of this work I agree to ' rform all work pursuant to rules governing the described construction.
SIGNATURE
ADDRESS
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:GENT/OWNER ~
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, DATE
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TELEPHONE #
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RECORD OF SEWER AND WATER DISCONNECTIONS
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Date /116~
of Building 4/1 14lL(~
Owner WIS I!dr. - ~ .
of Owner" { ----L7kv
J 19_by
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Address
Name of
Addre s s
Sewer Sealed at Property Line
Water Disconnected at Property Line
19_by
No sewer and water services to premises.
o
I, the undersigned, owner or agent of the above
agree that all sewer and water services wi~J.. )Se
sealed by a master plumber on or before )L/~
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described property,
discon ected and
1...5
Approved for issuance of wrecking or moving permit.
Date
Plumbing Inspector