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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
07028
TYPE:
BLDG D HTG D ELEC D PLBG d SIGN D ZONING
FLOOD PLAIN
HEIGHT
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OWNER
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PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Foundation
Class of Cons,.
Occupancy Permit
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 Ae-y ~.......--
+BT _WH _Disp
-!-Lav _Sh _OW
-J-WC _FOr _SP
_ WSoft
_OF
_ CBasin
_ San. Sewer
_Ur
_ Storm Sewer
_Sink
Other
_LTub
_ Eject
_SS
_ Water
FEES, ValuaUon $ ~ /
ISSUED BY ;7Cd. n/
7
Permit Fee Paid $ 9 ~/
Date "02/;{~
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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
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AGE lOW ~
DATE
ADDRESS
TE:LEPHONE #
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