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CITY OF OSHKOSH N2 21802
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:PERMIT APPLICATION AND RECORD
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TYPE: BLDG 0 T Ei ELEC 44 PLBG 0 SIGN El ZONING FLOOD PLAIN HEIGHT
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ADDRESS PLAN NO.
OWNER
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DESIGNER
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USE/NATURE OF WORK
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BUILDING CONTRACTOR
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Size k ', Sq. Ft. # Rooms # Stories Height
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Foundation Class of Const. Occupancy Permit
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HEATING CONTRACTOR
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Heat 0 A/C Li Vent El Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR d_ .rd i ' /e
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Electric Serv. New II Change E Temp 111 Type Volts Amps
Fixtures 'Switches /Pc
, 1 Receptacles 24, Circuits
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PLUMBING CONTRACTOR
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Lav , Sh DW DF San. Sewer
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WC , 1 FDr SP Ur Storm Sewer
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Sink r , LTub Eject SS , Water
Other
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FEES: Valuation $ -' C - Permit Fee Paid $ g --------- Park Dedication $
ISSUED BY Irl-i'a7 Date ./:%. ..1 &"" Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE 4100A0
, 1 AGENT/OWNER r DATE
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ADDRESS
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PERMIT NO . • APPL . DATE 1l 7
ELEC. CONTR.
OWNER
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NATURE OF WORK
ELEC. SERV. NEW GE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S 7" SW'S '2 RECEPT'S CIRC'
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL
EST. COST d ao% PERMIT FEE t5 DATE PD /j- lC��1)
REMARKS