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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
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32124
:":P_E~ _ _ ~L~G [~ _ ~~ _ ~ _ ~~E? _ ~ _ ~~BJ22/ D _ ZO_N~N_G _ _ _ _ _ _ ~~~~D_ P~'~ _ __ _ _ _ ~~'G~_ _ _ _ .
ADDRESS I \"'V ~ PLAN NO
OWNER E~- f~
DESIGNER
USE/NATURE OF WORK
; ~ HJp1
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC 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
_BT -LWH
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_ Disp _ WSoft
_ CBasin
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_Lav
_Sh
_DW
_SP
_DF
_San. Sewer
_WC
_FDr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $
ISSUED BY
<r30~oo
pP-
Permit Fee Paid $
Date
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~ - ~~
DATE
ADDRESS
TELEPHONE #