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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
09243
TYPE: BLDG D HTG D ELEC ~ PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
OWNER
(L7~
'-r~
f/z,Uy ~ S 1-:
L I nJl"'vV .
PLAN NO.
ADDRESS
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 SEe f..-Itre-
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
, Fixtures
Switches
Receptacles
Circuits ~
fP~
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
ISSUED BY
Permit Fee Paid $
Date
Lf- ,.)1
,00
~-(7 -TY
Park Dedication $
Final/O.P. 7 -I;?- -2'r
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
Jd,i ("-S~h,-.
AGENT/OWNER
7--/2-K~
DATE
SIGNATURE
ADDRESS
TELEPHONE #
OWNER
-;ul-yy-
PERMIT NO.C)
ELEC. CONTR.
. ADDRESS
NATURE OF WORK
ELEC. SERV. NEW
DESC. TYPE
FIX'S SW'S ~
APPLIANCES
CHANGE
VOLTS .
RECEPT I S
TEMP .
AMPS
cn~c' Sp<)
SIGNS
INSP. ROUGRIN
EST. COST
REMARKS