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CITY OF OSHKOSH N2 40568
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECX PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 3 / 3 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 ( 4,
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits ai
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 $ / a 0 • 0 0 Permit Fee Paid $ /0.0 v Park Dedication $
ISSUED BY � -�'� Date 7 /3f /Q 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 . VD-Cep , APPL . DATE 4 /2-7/4 SG
ELEC. CONTR
OWNER r /e
ADDRESS /3 / 3 ��
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP .
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGH]N SERVICE FINAL/UWitte
EST. COST /Oe2. c PERMIT FEEIn.c,) DATE PD. '!//L//Qr
REMARKS