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CITY OF OSHKOSH N°- 47064
PERMIT - APPLI ATI NAND RECORD
C O
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
c- /~~ _
ADDRESS ~ ~ ~ ~ ^-~ ~ ~ PLAN NO.
OWNER / ~',~~ `
r)FCIC~NFR
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
# Rooms
# Stories Height .
Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^
Fixtures Switches Temp ^ Type
Receptacles Volts
Circuits Amps
PLUMBING CONTRACTOR
- BT ~ WH _ Disp _ WSoft - CBasin
Lav _ Sh _ DW _ DF -San. Sewer
- WC _ FDr _ SP _ Ur -Storm Sewer
Sink _ LTub _ Eject - SS -Water
Other
FEES: Valuation $ ~3 ~ ~ ~ ~ Permit Fee Paid $ Q~~ ` ~ C~~ Park Dedication $
ISSUED BY ~ ~-~ Date / ' ~ ~ / s FinaUO.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ~
AGE T/OWNER DATE
ADDRESS
TELEPHONE ~