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35501
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
TYPE: BLDG D HTG D ELEC D PLBG J4r 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 S ~~L4- ~ f.L"'l
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---'- BT _ WH _ Dlsp _ WSoft _ CBasln
~ Lav ~h -'- DW _ DF _ San. Sewer
5 wc ~ FDr -'- SP _ Ur _ Storm Sewer
-L Sink 1 LTub -4-.. IT. Eject.. - SS - Water
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. 7'-00
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ISSUED BY
~60.00
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Permit Fee Paid $
FEES: Valuation $
Date
Park Dedication $
Final/O.P. 101.- /10 ,Q3
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE lL dJ '6 -/i -q 5
-' V' AGENT/OWNER DATE
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TELEPHONE #
ADDRESS
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