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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02776
TYPE: BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
/{("2c! 4:c-brvj' L.^_
CX.e<; 4_ A,/{ ~~fi--.s.c'~-
PLAN NO.
OWNER
DESIGNER
r)<'?h-e~ o~~?_ ~C?c(/L--
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
--f:
EL{i:CTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Heat Loss
BTU'S
Type _ Volts_ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR '- ~ ~t.e--/l.-;j
_ BT -'- WH _ Disp _ WSoft
_ CBasin
_Lav
_Sh
_DW
_SP
_DF
_ San. Sewer
_WC
_FDr
_Ur
_ Storm Sewer
_Sink
Other
_ L Tub
_ Eject
_SS
_ Water
/
FEES, Valuation $:;;;::;''''' :/ermlt Fee Paid $ ,~ . ~ Park Dedication $
ISSUED BY ~ ~ ~, Date ~/.y~? Final/O.P.
In the perto~~ w07\ agree to perto; all work pursuant to rules governing the described construction.
SIGNATURE::x. . Iv ~;~~~ <:-
AGENT/OWN DATE
ADDRESS
TELEPHONE #