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34952
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
TYPE: BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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Gr-,\{1;;I\'" 'R /12 e-- oS
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK~ ~ 1'2- /
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
~
Heat D NC 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
_WC
_FDr
_ L Tub
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_ Disp _ WSoft / _ CBasin
_ DW _ DF ~n. Sewer
_ SP _ Ur ~Storm Sewer
_ Eject _ SS ~ater
PLUMBING CONTRACTOR
_Lav
____ WH
_Sh
_BT
_Sink.
Other
FEES: Valuatio
ISSUED BY
/
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'~hJ
Park Dedication $
Final/O.P.
Date
In the pe"onnanee ofJ.\S Jr' rrm all worl< pursuant to ,"'es 90vemln9 the described consl;~n. / {, c '7:J
SIGNATURE t~
AGENT/OWNER DATE
ADDRESS
73s- / C:-LI
,
TELEPHONE #
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ADDRESS
OWNEIl
NATCU OF llOlUC
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fue
PLmmING PEIHIT APPLICATION
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REP AIIl
RELAY
!NSPECTION
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DAm
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DAm
#
Bachcub
Lavaco
Toilec
!ti.c. Sink
Sink(other
W te heater
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