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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
17684
TYPE: BLOG 0 HTG 0 ELEC 0 PLBGA8' SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
OWNER
/9s-2 /lui ja~~/
G. U/a/~_
PLAN NO.
ADDRESS
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 l ~~
_ BT -.L WH _ Disp
_Sink
Other
_FDr
_ L Tub
_DW
_SP
_ WSoft
_DF
_ CBasin
_Lav
_Sh
__ San. Sewer
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
FEES: Valuation $ (5tJl t:7O
ISSUED BY ~~fl7'/
~v'"
Permit Fee Paid $ 10
Date 1/--2-7#
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
r- ~.
Vi ~
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AGENT/OWNER
ADDRESS
TELEPHONE #