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N° 34964
* _ CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG AiSIGN ❑ ZONING FLOOD PLAIN HEIGHT
•
ADDRESS /i0 Os' /(/ e_dj PLAN NO.
144._../K
OWNER `
DESIGNER ��J�
USE/NATURE OF WORK %1 L/l� H
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C El Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTORS 1-1.--
BT / WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
I
FEES: Valuation $ (/1.6 00 Permit Fee Paid $ /0. 0 0Park Dedication $
ISSUED BY Date 7/' L/ 3 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREs..„,3 ‘.r----N.n '--1L'/ AGENT/OWNER DATE
ADDRESS
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