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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N!- 42069
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OWNER ~ ~~ ~ ~~
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Class of Const;
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type
Volts
Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_BT -LWH
_ CBasin
~
_Ur
_ San. Sewer
_ Storm Sewer
_ Water
_WC
_Sh
_FDr
_ L Tub
_DW
_SP
_DF
_Lav
_Sink
_ Eject
_SS
Other
FEES: Valuation $
ISSUED BY
V"VO ~ 00
~
Permit Fee Paid $
Date
I
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/oP0~
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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 #f /~ ~~- ~;j) 1<
TIOWNER
/O,,-/o/?j
, DATE
ADDRESS
TELEPHONE #