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CITY OF OSHKOSH N2 4263
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG [] SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS _ //�
PLAN NO.
OWNER
DESIGNER
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 ❑ Type
Volts
Amps
Fixtures Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
— 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 $ 7 ° ° • ° °
Permit Fee Paid $
•3 S� ' `' °
Park Dedication $
ISSUED BY =�"�
Date
/� /lT�y
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
DATE
ADDRESS
TELEPHONE #