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@ CITY OF OSHKOSH N~
~ PERMIT - APPLICATION AND RECORD
TYP.E: . . BL~~ .r:: . HT~. D. ELEi ~~B~ . D. ~'~N .r:: . ~ON I NG. . . . . . -"L~~D. ~~'N. . . . . . ~~'~HT. . . . .
ADDRESS / '9 j7 ~ A'
OWNER ~~dC. ~
21476
PLAN NO.
DESIGNER
USE/NATURE OF WORK
~ cx;l,.-A-'
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
Electric Servo
New cg.--'Change D Temp 0 Type
V""' Switches ~eptacles
Circuits ~
KJ---
ELECTRIC CONTRACTOR
Fixtures
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
.JC ~
Permit Fee Paid $ 0
Date / / ~/J.- --7' P
Park Dedication $
Final/O.P. ]- I -CjJ
.
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~*
ADDRESS
~ ~~?I-
/ DAfE
TELEPHONE #
PERMIT NO. '?-I t.f;7 f ,APPL. DATE 1& ""';:2/ -9 cJ
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t:7
/7 F1? - JI~ ~k-A1--
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CHANGE I
VOLTS '29'2.- c../-l9
RECEPT ......s ~
i-...
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW ~
DESC. TYPE } - Lt- - t/ -a
FIX'S ~- SW'S ~
APPLIANCES
TEMP.
AMPS ;t4""
CIRC'S p(
S I'GN S
INSP. ROUGHINC9lo( / ~ /1- r 0 SERVICE (JI( /(}~-2.:z-1() FINAL) -/- ?/ .
EST. COST ~ 000(,"'::- PERMIT FEE FtJ ~ DATE PD./f-9-eft)
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