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kh) CITY OF OSHKOSH N_ 38890
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC` PLBG
F] SIGN ❑ ZONING FLOOD PLAIN HEIGHT
--------------------)(----------------------- ••--------------- - - - - --
ADDRESS It / L
OWNER
DESIGNER
USE /NATURE OF WORK
PLAN NO.
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System
Heat Loss
ELECTRIC CONTRACTOR - L
Electric Serv. New ❑ Change�Temp E] Type Volts/ Amps I
Fixtures Switches Receptacles — Circuits _
PLUMBING CONTRACTOR
BT
WH
Lav
Sh
WC
FDr
Sink
LTub
Other
Disp
— DW
SP
Eject
WSoft
DF
Ur
SS
BTU'S
-- CBasin
-- San. Sewer-
--Storm Sewer
-- Water
FEES: Valuation $ G Permit Fee Paid $ c � _Park Dedication $
ISSUED BY Date — Z _ Final /O.P.
In the performance of this work I ag L.to perform all work pursuant to rules governing the described constriction.
SIGNATURE
AGENT/ NER DATE
ADDRESS
TELEPHONE #