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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
02233
TYPE:
BLDG 0 HTG 0 ELEC 0 PLBG ~SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
OWNER
/9'1/ S eTA!:. ~
. cA~r/-.~. ~~ cZ
PLAN NO.
ADDRESS
DESIGNER
.If
S~A- a/l---~//A/~~- ~~4
USE/NATURE OF WORK
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
Vi }7/v~ S;~ ~.
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer <//( /v C
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water ) ~ t"'e~;6Y"'
I'
Other
~"~
FEES: Valuation $: .
ISSUED BY C7'U/
/
15,=- v"
Permit Fee Paid $ .
Date (,;Z 1Jl, I~
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATUREs?<--.. ~ ~
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #