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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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Ng - 42798
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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 D AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
,.
~. ELECTRIC CONTRACTOR d~ /~C ffiA'.d~
P Electric Servo New ~ Change 0 ' emp 0 Type Volts 3aJ Amps "'"'h::7a
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
_BT _WH
_Lav
_Sh
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_WC
_Ur
_ San. Sewer
_ Storm Sewer
_Sink
Other
--,- Eject
__SS
_ Water
ISSUED BY
/
Permit Fee Paid $ ~ . 0 (;) j
Date I pi' /7 ,Y".
.,..........
Park ~ $
Finalib!p. J~..!. ~ . q5
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 #
l,q
:,' EC. SERV.
DESC. TYPE
FIX'S
APPLIANCES
. APPL. DATE 10 /"'J/f Y
, ,
ELEC.
OWNER
}\DDRESS 30 r;- r)
'flATURl:: OF WORK
CHANGE
VOLTS
RECEPT'S
TEMP.
AMPS U,o
CIRC'S
SERVICE
PERMIT FEE