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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
31670
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ADDRESS
PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
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 _WH
~Lav _Sh
-Lwc _FDr
G~r
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
-,
_ San. Sewer
_Ur
_ Storm Sewer
_Sink
Other
_ LTub
_ Eject
_SS
_ Water
FEES: Valuation $
17.l.(,,0 0
d7
Permit Fee Paid $
Date
/ ;1- _ 0 Co ~ Park Dedication $
//"// -V?..2- Final/O.P.
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ISSUED BY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER
K fr ~/o,2..
DATE
ADDRESS
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