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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
17631
TYPE:
BLDG D HTG D ELEC D PLBG,gr SIGN D 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
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC 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
PLUMBING CONTRACTOR
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_BT
LLav
_WC
~Sink
_WH
-LSh
_Disp
_ WSoft
_DF
_ CBasin
_FDr
_ L Tub
_DW
_SP
_ San. Sewer
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
Other
FEES: Valuation $ S"C57J C"O
ISSUED BY ~~~
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Permit Fee Paid $ /-2-
Date <3 ~ .3 D .- t't!J
Park Dedication $
Final/O.P. (11 /? ?It~
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ,zfJQ.-<J t ~
AGENT/OWNER DATE
ADDRESS
TELEPHONE #