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CITY OF OSHKOSH N~ 42384
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG [~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS
PLAN NO.
~ v
OWNER ~,~ ~L~
DESIGNER
USE/NATURE OF WORK l~ r QQ~Qr
BUILDING CONTRACTOR
Size
Foundation
Height
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles
# Stories
Class of Const.
- Heat Loss
Volts Amps
Circuits
PLUMBING CONTRACTOR `~ ~mOnS
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 $ ~ ~ ~ ~ Permit Fee Paid $ . ~ Park Dedication $
ISSUED BY ~~~ ~ Date ~~ ~ 'S Final/O.P.
/I y
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
ADDRESS
Sq. Ft. # Rooms
DATE
TELEPHONE ~