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CITY OF OSHKOSH
N° %� 26 � �:
� PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG� SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � �'�a � z 'Z � � PLAN NO.
OWNER �. �Z�c � „-�,.. �,/
DESIGNER J
USE/NATURE OF WORK ���� C��� � +�'�
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
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
GI I I�ARIN(_ (`QNTRAC'TnR r �'t?"f �
LBT �'WH �"Disp � —CBasin �
�Lav —Sh �"DW —DF —San. Sewer
�WC 1 FDr y5P —Ur —Storm Sewer
�Sink Z�T�����// —Eject —SS —Water
Other
�3f � j �- �
FEES: Valuation $ 7�/���'' �� � Permit Fee Paid $ �1, e C park Dedication $
ISSUED BY �"/�� Date �� � Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE � � "� " / 3�� y� � " /�.
A NTIOWNER �ATE
ADDRESS TELEPHONE N