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CITY OF OSHKOSH N2 42176
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ,'PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS J / PLAN NO.
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OWNER .!i,
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 /r.Ze-A■s'c-
a,; I iee-c >
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
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FEES: Valuation $ S O , O 1 Permit Fee Paid $ ZO • ca " Park Dedication $
ISSUED BY 7e -14 - -, -- -- Date /e /c3h 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 #
PERMIT NO 2 / 7 ro . APPL . DATE
El, C. CONTR.
OWNER
ADDRESS /9
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
PESO. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
,SIGNS
INSP. ROUGHIN SERVICE FINAL
EST. COST PERMIT FEE DATE PD. io /
RRKS
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