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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
N2
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34210
TYPE: BLDG D HTG D ELEC D PLBG.A5 SIGN D ZONING FLOOD PLAIN HEIGHT
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OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
_Lav
_WH
_Sh
6'~:
-Low
PLUMBING CONTRACTOR
_ Eject
_Ur
_SS
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
~
_BT
_ WSoft
_OF
_WC
LSink
_FOr
_ L Tub
_SP
Other
Permit Fee Paid $
Date
/
/6,061
C/;lc;?/~3
( I
Park Dedication $
Final/O.P.
FEES: Valuation $ ? .2-.:s-: 0 1:)
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ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE_(1J 1 dc, ~l;~
ADDRESS n'J" p~ ;F" ~4'{~
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