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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
01916
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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 D AlC D Vent D Fuel/System
Heat Loss.
BTU'S
Electric Servo
New D Change D
Switches
ELECTRIC CONTRACTOR
Fixtures
Receptacles
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
Permit Fee Paid $
Date
I
'i ~. ,,/
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Park Dedication $
Final/O.P. /0> -;;(C1 -% ~
ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 7??~ ~v;I
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DATE
ADDRESS
TELEPHONE #
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PERMIT NQ. r!) (-1' I P APPL. DATE /CJ -,;2-0-2l-b
ELEC. CONTR... ~~~. ... ...
OWNER ~ ~
t ADDRESS .:::2 ~. /S - ~ ~ ,.
NATURE OF WORK
ELEC. SERVo NEW
DESC . TYPE ) - LA--- ,.- 0 t4-
FIX'S SW'S
APPLIANCES
9IGNS
INSP. ROUGHIN t-
EST. COSTrlY 0_____
REMARKS