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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
25618
TYPE:
BLDG D HTG D ELEC D PLBG)z( SIGN D ZONING
FLOOD PLAIN
HEIGHT
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
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D AlC 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
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_Disp _ WSoft
_DW _DF
_SP _Ur
_ Eject _SS
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PLUMBING CONTRACTOR
_BT -I-WH
_ CBasin
_Lav
_ San. Sewer
_WC
_FDr
_ L Tub
_ Storm Sewer
_Sink
Other
_ Water
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FEES: Valuation $
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ISSUED BY
l('aa crO Permit Fee Paid $
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Park Dedication $
Date
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
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ADDRESS
TELEPHONE #