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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
26188
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PLAN NO.
OWNER
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ADDRESS
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 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
J((J;~
_Lav
_WH
_Sh
_Disp
~DW
_SP
_ WSoft
_DF
_ CBasin
Wd2!--
_BT
_ San. Sewer
_WC
_FDr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $
c ,2-e;, 0 0 Permit Fee Paid $
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1/- 7 --t:j /
Park Dedication $
Final/O.P. /0 - ~~ L/ - '/ i
ISSUED BY
Date
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
7/ 7 ~'l??J d-/~
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DATE
.ADDRESS
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TELEPHONE #