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CITY OF OSHKOSH N° 48421
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ' SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS l S 01 0 'i- nt, I st • PLAN NO.
OWNER
DESIGN
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
PLUMBING CONTRACTOR
_ BT WH _ Disp
Lav _ Sh _ DW
— WC _ FDr _SP
— Sink _ LTub _ Eject
Other
Volts Amps
Circuits
— WSoft
— DF
— Ur
SS
CBasin
San. Sewer_ — Storm Sewer
— Water
FEES: Valuation $ Permit Fee Paid $ L Park Dedication $
ISSUED BY r _ 3 ` —
Date ` - _Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
C:
SIGNATURE
AGENT /OWNER
ADDRESS
DATE
TELEPHONE #