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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
15467
TYPE:
BLDG D HTG D ELEC ~G D SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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(}Jo;f 0~
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK /J}alu J A' f LlluJ .
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
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Fixtures
New D Change D Temp D Type _ Volts _ Amps_
1.---. Switches L-- Receptacles L---- Circuits L..---
Electric Servo
PLUMBING CONTRACTOR
_BT
_WH
_Sh
_Disp
_DW
_SP
_ WSoft
_ CBasin
_Lav
_DF
_ San. Sewer
_WC
_FDr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
> ?~A-~o
FEES, valua~ oJ ~ _ p. ermit Fee Paid $
ISSUED BY .0 ~ .. Date
~CJ~
7-;? -% cz.
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Park Dedication $
Final/O.P. 7' -1.5 ~ g.:;
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATU ~../ /JreL
i~ -AGENT/OWNER
9/;~?/rc;
DATE
ADDRESS
TELEPHONE #
PERMIT NO.
.
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TEMP . ~
~~'S ~ ~
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^ FINAL)IJ-~
v.---DATE PD ~-17-
ELEC. CONTR.
;WNER
~ADDRESS
iATURE OF WORK
aEC. SERVo NEW
DESC. TYP
~;~iANC~;-SW'S
iI"GNS
INSP. ROUGHIN
EST. COST :3 JIJ
~EMABKS
=
CHANGE
VOLTS
RECEPT'S
{---- ...............
L-
;...-- .
SERVICE
PERMIT FEE :.J
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