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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N!! 43851
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OWNER (),;?--z_~-?:/v ~~-"----~
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DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size Sq. Ft.
Foundation
# Rooms
# Stories
Height
Occupancy Permit
Class of Const.
I
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_
. Circuits
Fixtures
Switches
Receptacles
PLUMBING CONTRACTOR
_BT _WH
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_Lav
_Sh
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
-1 San. Sewer
_ Storm Sewer
.i Water
vlcJL
L
_WC
_Ur
I~~
_Sink
Other
_ Eject
_SS
FEES: Valuation $
ISSUED BY
:>666.,66
Permit Fee Paid $
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~- .. '-' C Park Dedication $
~//''?/7 J- Final/O.P.
t /
Date
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIG~URE *~ ({\ ~
A'\ENT/OWNE~ .. DATE
ADDRESS
TELEPHONE #