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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N~- - 47595
TYPE: BLDG D HTG D ELEC D PLBG [Rf SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS I f3 ( {2 0
OWNER ~-+e}{~
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PLAN NO.
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONtRACTOR c...~yY)rYl0()3 -p j tJ.3
_ BT -L WH _ Disp _ WSoft
_ CBasin
L.
_Lav
_Sh
_FOr
_ L Tub
_OW
_SP
_OF
_ San. Sewer
_ Storm Sewer
_WC
_Ur
_Sink
Other
_ Eject
_SS
_ Water
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FEES: Valuat"n $.Y;;LL1 _ Parmll Fee Paid $ /0 J Park Dedication $
ISSUED BY ~ ________ Date /,0 ~I' .s ,,-;;; S- 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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SIGNATURE ?' . AGENT/OWNER. r 'J DATE
ADDRESS
TELEPHONE #