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� _ CITY OF OSHKOSH
N° 46101
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS I/?' S �• /`� !�'�`� PLAN NO.
I OWNER
I DESIGNER
USE/NATURE OF WORK�?
BUILDING CON1'RACTOR
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 �witches J''��Receptacles ��� Circuits `�
PLUMBfNG CONTRACTOR
_BT —WH _Disp —WSoft —CBasi�
_Lav —Sh _DW _DF —San. Sewer
—WC —FDr _SP _Ur —Storm Sewer
—Sink —LTub _Eject —SS —Water
Other
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FEES: Valuation $_'�"' �'=� Permit Fee Paid $ 3 � •�� j Park Dedication $
ISSUED BY �``— '�"'"'� Date 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�
Fi�I�Y�ST NO.e��/0/ • APPL. DATE
___
���C CONTR �0;�-���-���
OWI3ER.
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AI�DR.�SS I I Z- � /� '
NATURE OF WORK
C. SERV. NEW ""�`' ��'
C. E c VOLTS �-cJ Ai"�S /Z`'�
F`IX' S SW'S RECEPT' S CIRC' S
p,p ANCES
SIGNS z. FINAL
INSP. ROUGH N SERVICE ' �
EST. COST c� ERM T F E �'= o DATE PD.�
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