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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
05011
TYPE: BLDGJ(' HTG D ELEC D PLBG D SIGN D ZONING C-.2t FLOOD PLAIN cad- HEIGHT,N /4
ADDRESS \4 ~ I,ID~ \-\ 0 s;.'T r
OWNER ~cNtJC?:tH S"'C(-f M \EDEL
PLAN NO.
DESIGNER
~~E/NATURE OF WORK S:, CL L
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BUILDING CONTRACTOR
I '"
Size3'o yy-o
hy he.oe-L let";
Sq. Ft. ( 2. ..:) ~ # Rooms
# Stories
Class of Cons~. .:~
Height
Occupancy Permit tLb r4/Dv/;tU)
I
12-
Foundation
HEATING CONTRACTOR
A f /) /LlL
'Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR ,/J.J,AJ (,
Electric Servo New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
A....) eJ ,U<....
(
_Lav
_WH
_Sh
_ Disp
_DW
_SP
_ WSoft
_DF
_ CBasin
_BT
_ San. Sewer
_WC
_FDr
_ L Tub
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuati
ISSUED BY
Permit Fee Paid $ Z 0
Date '8 - 2. I - 81
Park Dedication $
Final/O.P.
A-
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE 1( ~ _~~
ADDRESS ; L{ 3 ./hddr- ,:::l rY ill4
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DATE
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