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37550
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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ADDRESS I/"'3 'f ~ PLAN NO.
OWNER . Jd4 'lb/aLt
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DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const;
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
/7 '.1. ,
ELECTRIC CONTRACTOR B~~ ~~ ~
Electric Servo New D Change D Temp D Type_ Volts_ Amps_
JO
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
_Sink'
Other
_FOr
_ L Tub
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_BT
_WH
_Sh
_San. Sewer
_Lav
_WC
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
FEES: Valuation $ / Va 0 .0 0
ISSUED BY ~~/.4."~
{/. , .
Permit Fee Paid $
Date
;
,
5"0.00: j
Ih/?CI
, r
Park Dedication $
Final/O.P. \ )"./? . 7 i
In the performanlJe of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREi;pU1 DU5ii~~"WN,".. i H5j,f
ADDRESS (). .
TELEPHONE #
(PIt-
PERMIT NO. '3 7S S"D . APPL. DATE (lY,4
ELEC. CONTR. ~--L/'1/ fZa{,;__
OWNER. ~)U) fMab
E EC. SERV.
DESC. TYPE
FIX'S SW'S
APPLIANCES
~,DDRESS
NATURE OF WORK
p
SERVICE FINAL ~
PERMIT FEE o. ;) DATE PD. I
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