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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
22226
TYPE: BLDG D HTG D ELEC ~LBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS /7;7/- ~ ~-
OWNER .~~ ,.
PLAN NO.
DESIGNER
~
USE/NATURE OF WORK
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 Newe(C;hange D Temp D TYP~
Fixtures L.---"' Switches ~ Receptacles ...-----
_.._t~l rJ
V~Amps~
Circuits ~ ~_
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
J
FEES, valua~ Permit Fee Paid $ 5' cJ~
ISSUED BY " Date / '- / ~-7/
.
Park Dedication $
Final/O.P. I - 'Z?--.AJ /
SIGNATURE
ADDRESS
TELEPHONE #
ELEC. SERVo
DESC. TYPE
FIX'S ~
APPLIANCES
;J-..~ :;22. ~. ,APPL. DATE / ./ -f7-j1Z)
~~
/ 7:i~~~
CHANGE . TEMP .
VOLTS I ~Q () AMPS ()
RECEPT I S 1.0:< CIRC '~fX1
/'
PERMIT NO.
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
S I'GN S
INSP. ROUGHIN
EST. COST
REMARKS
FINAL
FEE 5'd~ATE PD.