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38486
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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ADDRESS
3070 4~~~
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
# Stories
Class of Const.
I
Height
Occupancy Permit
~
. HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR .AA~~~ '/tr--v/ ~
tC-~ ~. ,
Electric Servo New~ Change D Temp D Type _ Volts_ Amps_
Fixtures Switches Receptacles . Circuits
PLUMBING CONTRACTOR
I
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _DW _DF _ San. Sewer
_WC _FDr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
FEES: Valuation $ r:tJ'a 0 . C)O Permit Fee Paid $
ISSUED BY ~ ~J.L",A/-h'-:- Date
/
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3f7frJC
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 ~
AGENT/OWNER
.y;;Cy
/ DATE
ADDRESS
TELEPHONE #
~ If
PERMIT No.3! iff c:. . APPL. DATE
ELEC. CONTR. ./c;~
. (
OWNER ~e",,~~
,
ADDRESS Jo i 0 ;<L~ ~
NATURE OF WORK ___
5/17!9<r
EtEC. SERV. NEW
DESC. TYPE
FIX'S SW'S
APPLIANCES
CHANGE
VOLTS
RECEPT'S
TEMP.
AMPS
CIRC'S
S I"GNS
INSP. ROUGH N
EST. COST 'l) @. .cO
REMARKS
SERVICE
PERMIT FEE
FINAL
." 0 DATE PD.