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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02838
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG g. SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
do2J. ~:b-'f
Z1~ As;>-e
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
Heat 0 AlC 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
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_BT
_WH
_Sh
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
~/ Co /t-i:::
_Lav
_ San, Sewer
_WC
_FDr
_ L Tub
_Ur
_ Storm Sewer
"
_Water / t" r /:f'__
_Sink
Other
_ Eject
_SS
Permit Fee Paid $
Date
I
/s~_'.;'
~/~J-'~?
Park Dedication $
Final/O.P.
ISSUED BY
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 #