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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
11506
TYPE:
BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
/723 ,J-l ~'/7
.;:z I rn /Y7~')'p'l?3 A
--
PLAN NO,
OWNER
DESIGNER
~~A 6~~
r"..~.6cr ~~t-~"':S'
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Cons~.
HEATING CONTRACTOR
Heat D AlC D Vent D Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Servo
New D Change D Temp D
Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR
1BT
-1- Lav
_WC
/A0/~~
_FDr
_Ur
_ CBasin
_ San. Sewer
_ Storm Sewer
_ Water
_WH
_Disp
_DW
_SP
_ WSoft
_DF
_Sh
_Sink
Other
_ L Tub
_ Eject
_SS
FEES, valuation;:;r~ A '
ISSUED BY d
~. ,
Permit Fee Paid $ t(-- ~
Date /.2(1 ~
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
rJ- {la/ , U t.:~
- AGENT/OWNER
Ce 2- 7-tf
/)~!-.~?
DATE
ADDRESS
TELEPHONE #