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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
07046
TYPE:
BLOG D HTG D ELEC D PLBG % SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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PLAN NO.
ADDRESS
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Foundation
Class of Const.
Occupancy Permit
HEATING CONTRACTOR
Heat D AlC 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 ~/hTJ
-!- BT -I- WH + Disp _ WSoft _ CBasin
~Lav .2 Sh -'-DW _DF _ San. Sewer
J WC --f- FDr -Lsp _Ur _ Storm Sewer
-L Sink $- L Tub L Eject < _SS _ Water
Other /- ~-1A/L~--? l~. ~p
.
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FEES, VaIUa!;O~)
ISSUED BY ~
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Perm;! Fee pa;dD:!e$;~J"
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
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DATE
ADDRESS
TELEPHONE #