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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
25230
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG 00 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
ADDRESS IdO /-JurOl" Av~
OWNER Q.lA.r~ Z:V"<Z5<L
PLAN NO.
DESIGNER
USE/NATURE OF WORK
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BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Class of Const.
Height
Occupancy Permit
Foundation
HEATING CONTRACTOR
Heat 0 NC 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
_WH
5('Lvy">~()r'\~} PfUMb/nc:.> O~hl-c(')-:,h
_ Disp _ WSott
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PLUMBING CONTRACTOR
_BT
_ CBasin
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_Lav
_Sh
_OW
_SP
_OF
_ San. Sewer
_WC
_FOr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $ 507 . <I S- Permit Fee Paid $
ISSUED BY L-.J f!c<!lf!:~~ Date
ID.co
9 -- 9~?/
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~' ~
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DATE
ADDRESS
TELEPHONE #