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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
21904
TYPE: BLDG D HTG D ELEC D PLBG ID SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
s~
PLAN NO.
OWNER
DESIGNER
,()J4.v SF- ~~
USE/NATURE OF WORK
BUILDING CONTRACTOR
~
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
FOl"ndation
Class of Const.
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
~ c~ c?J~
PLUMBING CONTRACTOR
v BT -L. WH ~ Disp
5 Lav -LSh LDW
f WC -.LFDr Lsp
~ Sink L L Tub ~ fl Eject
Other I-If.c~w~~ I
_ WSoft
_DF
_ CBasin
c.0~-
_ San. Sewer
_Ur
_ Storm Sewer
FEES: Valuation $ b ODD. 0 (/
ISSUED BY to ~
Permit Fee Paid $
_SS I_Water
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~ y. 06
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e ,
Date
Park Dedication $
Final/O.P. 3 -..- 1--=1,
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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GENTIO NER
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DATE
ADDRESS
TELEPHONE #
ADDRESS
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NATURE
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PERMIT APPLICATION ~
DATE /0//?/'.90 PERMITif.~/<Jof
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REP AI R
INTERIOR
RELAY
SAN SEW
WATER
STORM SEW
INSPECTION
DATE INSPECTION
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1.2-/Y/7t)
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(** Violation notes on the reverse sidel
DATE
Pipe
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