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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
BLDG D HTG D ELEC ~BG D SIGN D ZONING
26892
TYPE:
FLOOD PLAIN
HEIGHT
ADDRESS /3 9' /.tii fl- .
OWNER (l)~/ 14d~ ~AM-A~'
DESIGNER
PLAN NO.
USE/NATURE OF WORK
IP~~
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 J €..~~. , ~~eZ:;;'
, 1.
Electric Servo New D Change D Temp D Type _ Volts _ Amps_
Fixtures l,/" Switches ,/" Receptacles V Circuits ~
~
PLUMBING CONTRACTOR
_Sink
_FDr
_ LTub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_BT
_Lav
_WH
_Sh
_ San. Sewer
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
"Other
FEES: Valuation $ /5 () ()
ISSUED BY ~
Permit Fee Paid $ 50' 0-()
Date / - :> - j? ~
Park Dedication $
Final/O.P. /;2. - 3/-7/
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE c;?LAif-
ADDRESS
AGENT/OWNER
J- 7- 9 z..
DATE
TELEPHONE #
~-/2 -~
ELEC. CONTR.
OWNER
ADDRESS
NATURE OF WORK
ELEC. SERVo NEW
DESC. TYPE
FIX'S ,~ SW'S
APPLIANCES
~.
TEMP.
AMPS
CIRC'S ~
SI'GNS
l.}lSP. ROUGHIN
EST. COST
REMARKS
SERVICE
PERMIT FEE / cP ~ DATE