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CITY OF OSHKOSH N2 39684
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC' PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /2-9(2 W 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 22 JJ
Electric Serv. New ):Change Temp Type Volts31LJ Amps /d d
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 c70 0 0 Permit Fee Paid C) c) Park Dedication
ISSUED BY Lam✓ Date 17/9 Final /O.P. o 'a 9�
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 #E