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CITY OF OSHKOSH N- 46244
� PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ..
ADDRESS � PLAN NO.
OWNER ��
DESIGNER
USE/NATURE OF WORK �GL �-�yc�
BUILDING CON7RACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
FI FCTRIC CnNTRACT�R � • �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
FEES: Valuation $ � �� �� � Permit Fee Paid $ � Jr� J � Park Dedication $
ISSUED BY Date Final/O.P.
In the pertormance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TELEPHpNE#