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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
16331
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R'J 7 61-) mer v./.
j1/th'PIA A>)b~/
ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
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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
PLUMBING CONTRACTOR S~ /?Z~
_BT LWH _Disp
_Sink
_FOr
_ L Tub
_OW
_SP
_ WSoft
_OF
_ CBasin
_Lav
_Sh
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
Other
/
.7. ~. ~ ,/.
FEES, Valua!;on ~~ ' PenTI;! Fee Pa;d $ 10
ISSUED BY . ~/~ Date II-?~d
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE
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AGENT/O ER . .
DATE
ADDRESS
TELEPHONE #