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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02677
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ADDRESS ~/J- ~~L ~ .
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PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const;
,..
HEATING CONTRACTOR
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Heat D NC D Vent D Fuel/System
Heat Loss'
BTU'S
ELECTRIC CONTRACTOR
~
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,
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Fixtures
New D Change D Temp D Type _ Volts_
/ Cswitches ""-~eceptacles ~-='Urcuits
Amps 2~
-><-- .. ~l
Electric Servo
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
Other
ISSUED BY
Permit Fee Paid $
Date
Park Dedication $
iI Id?-)t' 7
5'tJ 0
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Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~~
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/ DATE '
ADDRESS
TELEPHONE #
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PERMIT NO.
ELEC. CONTR.
ADDRESS
NATURE OF WORK
TEMP .
AMPS.::L
CIRC'S
IGNS
INSP. ROUGHIN ,~ -
EST. .. COST / 2. 6i t?~
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