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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02062
TYPE: BLDG D HTG D ELEC D PLBG g SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
9 20 A/S/~i4'~'(
.;;:?;;',Vl r".-,-_ .A-c>~-e~ F1/t&_~
PLAN NO.
ADDRESS
DESIGNER
rs~ie~~ ~~'/C!k-- A:.~eL-,
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.
Height
Occupancy Permit
Foundation
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 0a~ /7A~-r ~
_BT -LWH _Disp
_Lav
_Sh
_OW
_SP
_ WSoft
_OF
_WC
_FOr
_ L Tub
_Ur
_ CBasin
_San. Sewer
_ Storm Sewer
_ Water
_Sink
Other
~ Eject
_SS
";? .- .~
FEES: Valuation $ 0 3D ./ Permit Fee Paid $
ISSUED BY ~ ~/ Date
/
~'~. ~
/y'/~
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~_ML~ lAA~ ~ 11- }':i-~c;,
AGENT/OWNER \ DATE
ADDRESS
TELEPHONE #