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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
14660
TYPE: BLDG 0 HTG 0 ELEC 0 PLBCVKJ SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
ADDRESS
511 If 1t1!, PLAN NO
~~ 7J-/1!-
f r
OWNER
DESIGNER
r'r/;(C"/?-1.O~A I tA/~~. ,~pa~
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat 0 AlC 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
PLUMBING CONTRACTOR c;, ft:- t' ~
_ BT -I- WH - Disp
_Lav _Sh _OW
_ WSoft
_OF
_ CBasin
_ San. Sewer
_WC
_FOr
_ LTub
_SP
_Ur
_ Storm Sewer
_Sink
Other
_ Eject
_SS
_ Water
FEES: Valuation $ ~5 DO c- Permit Fee Paid $
ISSUED BY ,~----&--c~.. Date
/6 o-cl r/'
? -_/ -p?
Park Dedication $
Final/O.P.
In the performance of this work I agree to perform all work pursuan' !o rules governing the described construction.
SIGNATURE
/11 U11J)~ ~ '
:::J AGENT/OWNER
/9'0 J .As}; /" .wi.
DATE
ADDRESS
TELEPHONE #