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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N!- 43628
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PLAN NO.
ADDRESS
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
" HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
~
ELECTRIC CONTRACTOR ~L~
Electric Servo New D Chang~ Temp 0 Type'LJ6. vo,t;3 tAl Amps/II
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
_Lav
_WH
_Sh
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_ San. Sewer
_BT
_WC
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $ SOO. D a Permit Fee Paid $
ISSUED BY ~ Lt~~ Date
/
/
5&.00/
f h~ f; S-
f .
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
DATE
AGENT/OWNER
ADDRESS
TELEPHONE #
L.. ~ I
PERMIT NO. f 3~ z,(
ELEC.. CO~TR. L5~
OWNER
"ADDRESS ~YIHl~
NATURE OF WORK
\,~'S:~
. APPL. DATE
i
1,3Y; 7Ai'~
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ELEC. SERVo NEW
DESC. TYPE
FIX'S SW'S
APPLIANCES
~f'N("..E.> /s; 0
VOLTS
RECEPT IS'
I.
TEMP.
AMPS lOr.)
CIRC'S
SIGNS
INSP. ROUGHtN
EST. COST c;-.~ 0
~KS
PERMIT
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