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CITY OF OSHKOSH No 41229
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG F] SIGN E] ZONING FLOOD PLAIN HEIGHT
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ADDRESS ��� PLAN NO.
OWNER—,
DESIGNER
USE /NATURE OF WORK
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 ❑ Temp ❑ Type.
Fixtures Switches Receptacles _
Volts Amps
PLUMBING CONTRACTOR
— BT —
WH
— Disp
_ WSoft
_ Lav —
Sh
_ DW
— DF
WC —
FDr
—SP
— Ur
— Sink —
LTub
— Eject
—SS
Other
Circuits
— CBasin
— San. Sewer-
- Storm Sewer
—. Water
FEES: Valuation °� �9 S� Permit Fee Paid $ KGs Park Dedication $
ISSUED BY Date b �-3_ 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
DATE
TELEPHONE #