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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
12159
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ADDRESS
PLAN NO.
OWNER
DESIGNER
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USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const;
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
,l!
Heat Loss.
BTU'S
ELECTRIC CONTRACTOR S? c/c2i l;f"ic fy-;'e-
Elec:ic Servo New D Change ~ Temp D Typei:SW VOlt~ ;;2Jlo Amps/OO
Fixtures Switches Receptacles Circuits..-\;
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PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY
Permit Fee Paid $
Date
:20. O~
/ --;;)..L) - F 1
Park Dedication $
Final/O.P. I -I 7~' %r
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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GENT/OWNER
/-;20 --5 ~
DATE I
SIGNATURE
ADDRESS
TELEPHONE #
PERMIT NO.
ELEC. CONTR.
OWNER
~DR~~S
~~ OF WORK
E EC. SERVo
DE C. TYPE
FIX'S
AEPLI~CES
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RECEPT'S
SIGNS
INSP. ROUGHIN
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FJ:MABKS
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