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~
CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
21524
TYPE:
BLDG D HTG D ELEC % PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS ~~~
OWNER ....
PLAN NO.
DESIGNER
USE/NATURE OF WORK ~J .~A-"~
;2 -- ]~ ~ ') '-/120
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 CONTRACTO
Electric Servo
New ~ Change D Temp D
Type Ll...1.L-
Amps/...OO
rQ
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Qther
ISSUED BY
tJ ,- b c..
::--- Permit Fee Paid $ ;l..t9---
Date //-/ 1-9 cJ
'--'" ....
Park Dedication $
Final/O.P. /' 6 - jl / - Pc.?
SIGNATURE
work I agree to perform all work pursuant to rules governing the described construction.
AGENT/OWNER
}/ Jaflo
, I I DATE
ADDRESS
TELEPHONE #
ELEC. CONTR. ~
OWNER ~. 62~
ADDRESS ;;< ( 1 '- ~. i
NATURE OF WORK
-yZ)
PERM!T NO. ::< I ~ -:2-
SIGNS
INSP. ROUGHIN
EST. COST
RE:r.1..ARKS
If-f ~ :;--
CHANGE
VOLTS 12-/{-1
RECEPT/S "-
! tI
I
C~~ .'
SERVICEOIf( -10 -3i"- tJ FINAL/.?' -31-<jp
PERMIT FEE.;l. ()~ DATE PO II-/~ -9.0
TEMP.
AMPS '0-0
CIRC'S'~
ELEC. SERV. NE'Il
DESC. TYPE ~/ftP 1/ ~?ti/ i ~!IV /I v
FIX'S SW'S
APPLIANCES