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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
YI/
33320
~~P_E~ - _~L~~ -~ _~T~_l?- ~~E~_l?- ~~B~_W ~I~~ -~ _~O_N~N~_~- _F~~~D_~~I~~ - ~~I~~T~
OWNER
2/(p PAId w/n
~Ut t./í ng-cr
PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK (f,{)/tJCf'/ L¿ later h.¡:>t'1.J.tr
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
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 \31 mmonÔ
- BT --X. WH - Disp
_WC
_Sh
_FDr
_DW
_SP
_DF
- CBasin
- San. Sewer
~
_WSoft
_Lav
_Ur
_Storm Sewer
_Sink
Other
_LTub
_Eject
_SS
_Water
FEES: Valuation $
ISSUED BY
:35CJ , ð()
jØL
Permit Fee Paid $
Date
/-0_00
¡£-.;. :? - 7' J
Park Dedication $
Final/O.P.
In the pertormance of this work I agree to pertorm all work pursuant to ruies governing the described construction.
+29-93
DATE
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AGENT! ER
SIGNATURE
ADDRESS
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