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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
11235
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG ~ SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
OWNER
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PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const,
Height
Occupancy Permit
Foundation
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
PLUMBING CONTRACTOR
_BT _WH -2- WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
/
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FEES: Valuation $ L/ Permit Fee Paid $ .
ISSUED BY ~--Z/0r.)~~ Date 1/ 4 ~
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 cL O~ ~ /1- /0- 'iflf
AGENT/OWNER DATE
ADDRESS
TELEPHONE #