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~
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
Vol
N~-41557
~~:E~~ ~L~~ -~ -:: ~~ ;;7~- _ _ _ _ _ _~~D_ ~~:~~ ~~_ _ ~~I~~T_ - - - -
OWNER K......_~
USE/NATURE OF WORK
,AI~ r -
6-L.L~
DESIGNER
BUILDING CONTRACTOR
r, 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
=:r
~--
_BT
_WH
_Sh
_FOr
_ L Tub
_ Disp _ WSoft
_OW _OF
_SP _Ur
_ Eject _ SS
_ CBasin
-L San. Sewer
1 Storm Sewer
-L Water
~
Vlvc
y (JV c
IL
_Lav
_WC
_Sink
Other
FEES: Valuation $ I-s-a 0 ,0 6
ISSUED BY /~~ ----
Permit Fee Paid $
Date
2 0 , <::) 0
9~</;7Y
/ /
Park Dedication $
FinaVO.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
~R
AGENTIOWNER ~ I.? A
95'( vJr ;CrS/ ~ (~~
'1-/,;2 - 9t;/
DATE
ADDRESS
~5 "VS-O
TELEPHONE #
ADDRESS
cr.mtl.
NA~
SAN sml
iJATEI.
PEDrr APPLICATION
DAt! ~ /.2. ?
-13"-
-E)
BEPAIlt
nrr.!nol.
#
Bathtub
LaV&to
Toilet
DAD ltit. Sink
Si.nk(other
W te heater
PECTION
DATE
INSPECTION
** Violation notes on the reverse side(
PEmc:T# V/S-S-?
#
Sum Pu
Ej ector
Water Softener
Drinkin Fountain