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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
25620
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OWNER
/32- 11/0 /-116-1-/
B /2-/ JJ J:::-/!4 I9-J
PLAN NO.
ADDRESS
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,
DESIGNER
USE/NATURE OF WORK
O/'~tY
'-h
Ct7/~ -I-
BUILDING CONTRACTOR
Size.
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
I
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 ~WH
_Disp
_ WSoft
_DF
_ CBasin
_Sink
Other
_FDr
_ L Tub
_DW
_SP
_ San. Sewer
_Lav
_Sh
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
FEES: Valuation $
"'2 (') 6 a () P . F P'd $
'. ermlt ee al
W V4~~~-
v
DP ;:::-~~ /
~27_6o /
-. ,
I' (;) .,-- 1 -cz/
Park Dedication $
Final/O.P.
ISSUED BY
Date
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ))L z- ~ /6~~/
ADDRESS
TELEPHONE #