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CITY OF OSHKOSH N° 32130
PERMIT - APPLICATION AND RECORD
TYPE: BLDG 0 HTG 0 ELEC D PLBG 4] SIGN ❑ Z NING FLOOD PLAIN HEIGHT
ADDRESS
90)- /(/• 4--- PLAN NO.
OWNER . 0 it// 7 1
,
DESIGNER f/f�
i USE/NATURE OF WORK 414, ' "
,/
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
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR J
�L
BT WH —Disp WSoft __CBasin
-Lay —Sh —DW DF San. Sewer
_WC —FDr SP Ur —.Storm Sewer
-Sink LTub —Eject SS —Water
Other
FEES: Valuation $
3 �0 . 0 a Permit Fee Paid $ / 0 - O Park Dedication $
2/3 /' 7_ Final/O.P.
ISSUED BY � Date /
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ���—�
AGE OWNER DATE
ADDRESS
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