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CITY OF OSHKOSH N- 40333
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS I~..D~9 w ~ ~~~ PLAN NO.
OWNER ~Q ~W ~ Q ~~
DESIGNER
USE/NATURE OF WORK ~~QX~
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft. # Rooms
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
# Stories
Class of Const.
- Heat Loss
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type
Fixtures Switches Receptacles .
Volts
Circuits
Height .
Occupancy Permit
BTU'S
Amps
PLUMBING CONTRACTOR Jn..rn.~CSY. 'b
BT ~ WH _ Disp - WSoft - CBasin !~i~
- Lav - Sh - DW - DF -San. Sewer
- WC - FDr - SP _ Ur -Storm Sewer
-Sink - LTub -Eject - SS -Water
Other
FEES: Valuation $~~~~ Permit Fee Paid $ ~L~~~ Park Dedication $
ISSUED BY ~ ~~1~ Date ~'~~~y Final/O.P.
In the performance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNATURE ~~~
AGENT/OW DATE
ADDRESS
TEIEPNONE ~