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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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32448
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OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Constr
HEATING CONTRACTOR
Heat 0 NC 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
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PLUMBING CONTRACTOR
-1WH
A
L _C;~
_Lav
_Sh
~FDr
_LTub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_ San. Sewer
~
_BT
_WC
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
/
,
...
FEES: Valuation $
ISSUED BY
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Permit Fee Paid $
Date
/D. 0 ~
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Park Dedication $
Final/O.P. I//q 19.1
I I
In the performance of is work I agree to perform all work pursuant to rules governing the described construction.
AGENT/OWNER
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ATE
SIGNATURE
ADDRESS
TELEPHONE #