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CITY OF OSHKOSH N2 41433
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG X SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS C��-� -`� ' 1 �� PLAN NO.
A ., «
OWNER
DESIGNER
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms
Foundation Class of Const
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts
Fixtures Switches Receptacles
# Stories Height.
Occupancy Permit
Circuits
Amps
BTU'S
PLUMBING CONTRACTORnnmrnc
ns
— BT T WH
— Disp
— WSoft
— CBasin
— Lav _ Sh
— DW
— DF
— San. Sewer
— WC _ FDr
_ SP
— Ur
— Storm Sewer
Sink — LTub
Eject
—SS
Water
Other
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FEES: Valuation $C1•' Permit Fee Paid $ 66 Park Dedication $
ISSUED BY � Date l 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