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CITY OF OSHKOSH N~
PERMIT - APPLICATION AND RECORD
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39460
~~P_E: - _~L~~ -~ _~T~_~- ~~E~_~- ~~B¡é- ~I~~ -~ _~O_N~N_G_~- _F~~~D_~L~I~~_~~I~~T~
ADDRESS ;:2-;3 :? 1/1/ / 7/'7>7" PLAN NO.
~~ ,~ r 12----
::::::;:RE OF WORK K Jh~~~/;b!2 ( ~~ ~S )
OWNER
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU.S
ELECTRIC CONTRACTOR
Electric Servo
New 0 Change 0 Temp 0
Type - Volts - Amps-
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
6- ~~~
_Disp _WSoft
_DW _DF
-SP -Ur
_Eject _SS
- CBasin
- San. Sewer
~
_BT
_WH
-Sh
_Lav
_WC
-.L Sink
Other
-FDr
_LTub
- Storm Sewer
_Water
FEES: Valuation $
,ð 0
Permit Fee Paid $ /8~O 0
Date rÞ;~,~
Park Dedication $
Final/O.P.
ISSUED BY
g,
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~--"--1 ~T/OWNER
S', Ib- '1L/
DATE
ADDRESS
TELEPHONE #