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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
16106
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ADDRESS
PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.,
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat 0 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
PLUMBING CONTRACTOR
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_BT _WH _Disp
_Lav _Sh -!-DW
_WC _FOr _SP
_Sink _ L Tub _ Eject
Other
_ WSoft
_ CBasin
_DF
_ San. Sewer
_Ur
_ Storm Sewer
_SS
_ Water
C'~
FEES: Valuation $ .3o-'V
ISSUED BY ~/'e;Y7:--~~
Permit Fee Paid $ / D c/'.". \/'
Date /'0 - 31,-- f?7
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
DATE
ADDRESS
TELEPHONE #