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(rft CITY OF OSHKOSH N° 43943
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC j PLBG ❑ SIGN F-1 ZONING FLOOD PLAIN HEIGHT
ADDRESS PLAN NO.
OWNER
DESIGNER yj
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System
# Rooms
Class of Const
Heat Loss
# Stories
Height _
Occupancy Permit
// 1
ELECTRIC CONTRACTOR / /V / ✓ /-�
Electric Serv. New Change ❑ Temp ❑ Type Volts 3 � Amps
Fixtures Switches L/ Receptacles Circuits
PLUMBING CONTRACTOR
_BT _WH
Lav _ Sh
WC — FDr
Sink _ LTub
Other
— Disp
_ DW
—SP
— WSoft — CBasin
Ilia
Ur
BTU'S
— San. Sewer-
- Storm Sewer
Eject _SS _ Water
FEES: Valuation $ O O ° `� Permit Fee Paid $ �� V Park Dedication $
ISSUED BY Date 3�J 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