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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
10189
TYPE:
BLDG D HTG D ELEC ~BG D SIGN D ZONING
FLOOD PLAIN
HEIGHT
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ADDRESS
, "303
(3 , .s.-"" 0.-- (l.. ("J~
Sc~uJ"L
PLAN NO.
OWNER
o <2.c;.~
DESIGNER
USE/NATURE OF WORK
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()... \ /"L..
,
Co.~" A , '~t :;;." G! ....
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR C h v v..J.."" t: (e c ~ 11- l c...-
Fixtures
New D Change D Temp D
Switches y/"
Receptacles
Type_ Volts_ Amps ~3c'
Circuits V
~(
Electric Servo
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ LTub _ Eject _SS _ Water
Other
FEES: Valuation $ /) d <:'. C_ Permit Fee Paid $
ISSUED BY ~~ Date
/~~-
zr- 3 / ~-TT
Park Dedication $
Final/O.P. T - 3' / ---78?
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
&-J 'l~~~V"Vl-"-
AGENT/OWNER
2/3//9?
DATE .
ADDRESS
TELEPHONE #