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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
05468
TYPE:
BLDG 0 HTG 0 ELEC 0 PLBG~SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
USE/NATURE OF WORK
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PLAN NO.
ADDRESS
OWNER
DESIGNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const. .
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR ~ ~ ,r;:-','f?r/'f
_ BT _ WH _ Disp _ WSoft
_ CBasin
,
_Lav
_Sink
Other
_FOr
_ L Tub
_OW
_SP
_OF
_ San. Sewer
_Sh
_WC
_Ur
_ Storm Sewer
_ Eject
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'-- SS _ Water
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FEES, VaIUati~="-- Perm " Fee Paid $
ISSUED BY / ~)(r ~ Date
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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 -^- Ii) ",~~A1ii.1.
. ....... A T/OWN R
DATE
ADDRESS
TELEPHONE #
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