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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
28354
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PLAN NO.
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DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR W.-r
Size~ S~. Ft.
Foundation
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# Rooms
Class of Const.
# Stories
y
,
Height
Occupancy Permit #)
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
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
FEES: Valuation $ f~OO. 0 () Permit Fee Paid $
ISSUED BY ~rl(~.vU4.A~ Date
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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 '-I5etU..d. ~ _
AGENT/OWNER
5~f-q~
DATE
ADDRESS
TELEPHONE #