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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
28675
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ADDRESS
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
lCorQ, WI-l-
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
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
_Sink
Other
_FOr
_ LTub
_OW
_SP
Plbj
_ WSoft
_OF
_ CBasin
_ San. Sewer
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PLUMBING CONTRACTOR ()~.A
_ BT -Y.- WH - Disp
_Lav
_Sh
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
375. ().7
~ft:-
Permit Fee Paid $ /0 . 0 0 Park Dedication $
Date :s; /- Y7 ~ Final/O.P.
FEES: Valuation $
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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DATE
ADDRESS
TELEPHONE #