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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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Ng 40363
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OWNER /~u4-1 ~tt? ~~.-
ADDRESS
PLAN NO.
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
..
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
, ELECTRIC CONTRACTOR ~Wr? /(f;-<'d.l~
Electric Servo New~ Change 0 Temp 0 Type tI Volt;? W Amps/O'V
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_FDr
_ L Tub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_WC
_Ur
_ San, Sewer
_ Storm Sewer
_Lav
_Sink
Other
_ Eject
_SS
_ Water
o
Permit Fee Paid $
/
~O. to '0/
7/7/9 V
Park Dedi~ $
Final/o?[--;j', & .15
ISSUED BY
.....--
Date
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
PERMIT NO. rtJ,3' 3
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ELEC. CONTR. ... ..... ...." 1~
OWNER r~ J~ 'f'4-~
ADDRESS 30 ~ ~ II~ ~
NATURE OF WORK ./?g..:.t.} ~
ELEC. SERV. NEW ~ CHANGE
DESC. TYPE ~ VOLTS 3c.d
FIX'S SW'S RECEPT'S'
APPLIANCES '" I
.1
,', V
S ERVI CE .?;s.~ Jt
PERMIT FEE
. APPL. DATE 7~ h </
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TEMP. .thJ
AMPS!'
. CIRC' S
SI'GNS
INSP. ROUGHIN ?f"- (~ ~
EST. COST
REMARKS
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FINAL (41i~
DATE PD. .
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