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CITY OF OSHKOSH N°- 38286
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~ ~ ~ s iy"///i~~~~ _~_ .
OWNER
DESIGNER
PLAN NO.
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms
# Stories Height
Foundation Class of Const.
Occupancy Permit __
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^~ Fuel/System Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ T e
YP Volts Amps
Fixtures __ Switches __ Receptacles _________
Circuits
PLUMBING CONTRACTOR -=-~
- BT -~_ WH
- Lav - Sh
- WC - FDr
.-Sink - LTub
Other
- DW
-. SP
Eject
-- WSoft
- DF
____ Ur
- SS
- CBasin
-San. Sewer.
-Storm Sewer
- Water
FEES: Valuation $_ ~~` ~ ~ ®d Permit Fee Paid $ ~®~ ~ ~
ISSUED BY /~~ Park Dedication $_
~~ Date Z Zy !~ Final/O. P. -
In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction
SIGNATURE
ADDRESS
~W~9~
TELEPHONE k