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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
11665
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
17:!I:Zck~
PLAN NO.
ADDRESS
DESIGNER
reruo-r/l k/ Ic/ ~
9* /o0~
..
f/l.;o.
q~? ~17V\. ~ ,oeA' //7/[ / I
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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
Heat LosS;
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR C h~ ~ifL~
_ L Tub
_ Eject
_SS
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
_FDr
_Disp
_DW
_SP
_ WSoft
_DF
_BT
_WH
_Sh
_Lav
~WC
--L Sink
_Ur
Other
ISSUED BY
5-~
Permit Fee Paid $
Date /2- /2 ,..~
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNAT:~=;;? it; ~ ~ => --=
AGENT/OWNER
ADDRESS
TELEPHONE #