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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
27504
TYPE:
BLDG ~TG D ELEC D PLBG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
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Size
Sq. Ft.
# Rooms # Stories Height
Class of Const. kM~i~~)ccupancy Permit
Foundation
AID
HEATING CONTRACTOR
Heat D A/C 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
'----.--.-.--
_WC
_WH
_Sh
_FDr
_ L Tub
_Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_BT
_Lav
_ San. Sewer
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
ISSUED BY
Paid $
Date
/
./
Park Dedication $
Final/O.P.
In the performance Of' this work I agre,e to ~#ork pursuant to rules governing the described construction.
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SIGNATURE /...-- --{.. _
/ i/ AGENT/OWNER DATE
ADDRESS /? Y 7 ~~~ ~. 4/~ L ~ :3 --?d:<" v
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