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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
)/0/
N! 44431
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:::ERSS 3rz:7~ f ~--<- PLAN NO
DESIGNER ~
USE/NATURE OF WORK fi L - 0 ~ ~/
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const1
HEATING CONTRACTOR
~ Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type
Volts_ Amps_
Circuits
Fixtures
Switches
Receptacles
PLUMBING CONTRACTOR
_BT _WH
-1
~4~
_Lav
_Sh
_FDr
_ L Tub
_Disp _ WSoft _ CBasin 1fv~ ~
_DW _DF -L San. Sewer
_SP _Ur -+- Storm Sewer V Iv c
_ Eject _SS -I- Water I ~
_WC
_Sink
Other
FEES: Valuation $ /' --S-OC> . e 0
~
Permit Fee Paid $
Date
/
~<D . C) 'e.j J
V/-~hs-
I /
Park Dedication $
Final/O.P.
ISSUED BY
SIGNATURE
f this work I agree to perform all work pursuant to rules governing the described construction.
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ADDRESS
AGENT/OWNER
td.m/ ,4(1 ~
os,;:::~
DATE
M
e:235~~ ?lS-G
TELEPHONE"
ADDRESS
CJm!R
NAnm!
INC PEBMI-r APPLICATION
DAD V,(C6/9.s- PEBHIT# Y0'~J/
p . / =r ~--(7A'''--'~
--0
REPAIR
DA'l'E
#
Baehcub
LavacD
Toilec
ltic. Sink
Sink(other
W te heater
#
snCTION
DAn:
msncnON
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