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CITY OF OSHKOSH
N° 46205
PERMIT - APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 Al 411-44 PLAN NO.
OWNER .011,t)ard /—ich1e
DESIGNER / c ` /�USE/NATURE OF WORK V j4. 7 // `.. riy( v/O/V a o`Hy) ce 04 P 1, , Lv
BUILDING CONTRACTOR RBC Wk-) 1/1-1-
Size Sq. Ft. # Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent 0 Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change 0 Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
._BT —WH _Disp —WSoft —CBasin
Lay —Sh DW —DF __San. Sewer
_WC —FDr SP —Ur —Storm Sewer
__Sink —LTub _Eject —SS Water
Other
al AID.
b'� O
FEES: Valuati �(0000Perm't .r = Paid $ 3J ---- - Park Dedication $
ISSUED BY ' ' •� ' Date1-7-0)--I-F5;' Final/O.P.
0
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE2•11-u-e-A--oe ce.e..-cf&-c2)-a3-1. ^ L{ 9`�
AGENT/OWNER� DATE
ADDRESS y �j 1 �. 1 '/fir i 3/ if 7 6 D
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