HomeMy WebLinkAbout0028128-HVAC (a/c)~ CITY OF OSHKOSH N°- 28128
`' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ~ ELEC ^ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS! ~~ ~ ~~~ t ~~~, ~° C.L/ PLAN NO.
OWNER ~i `ly N ~C! ~ h
DESIGNER
USE/NATURE OF WORK ~ G' J "
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
# Rooms
Class of Const
# Stories
Height .
Occupancy Permit
EATING CONTRACTOR U't-~`"~ /7'L!/55=~~i S f'~" /9° `b+~ /7-L ~--
Heat ~ A/C ^ Vent ^ Fuel/System ~~Heat Loss ~ ~< i5 T BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles
Volts Amps
Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft
Lav Sh DW DF
WC FDr SP Ur
-Sink LTub -Eject SS
Other
CBasin
-San. Sewer_
-Storm Sewer
Water.
FEES: Valuation $ Permit Fee Paid $ ,~ 5 - CEO Park Dedic
t
ion $
a
ISSUED BY Date y/~ g~ /
~
~
Final/O.P. `~` ~~- ~~'+
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
ADDRESS
y «/~~
DATE
~~~s~~
TELEPHONE #