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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
10645
TYPE: BLOG 0 HTG 0 ELEC 0 PLBG [!2(SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
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OWNER
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PLAN NO.
ADDRESS
DESIGNER
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USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
, Occupancy Permit
Class of Const.
Foundation
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
_FOr
_ L Tub
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_Disp _ WSoft
_OW _OF
_SP _Ur
_ Eject _SS
PLUMBING CONTRACTOR
_Lav
_WH
_Sh
_ CBasin
_BT
_ San. Sewer
_WC
~Sink
Other
_ Storm Sewer
_ Water
Permit Fee Paid $
Date
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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~~R.~): Q ~ ~,,~w~
. AGENT/OWNER ~ ~..........,
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DATE
ADDRESS ~
TELEPHONE #