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CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
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N~t - 42781
TYPE: BLDG 0 HTG 0 ELEC 0 PLBG J8:: SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
ADDRESS ~~lQ~ ~) ~QQQr
OWNER~rrl mCtf ~
PLAN NO.
DESIGNER
USE/NATURE OF WORK~ () H-.Qf(l +1MlS -. 01~ tl1u('l Y1 1YrJh oxhm3
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
Occupancy Permit
Foundation
Class of Canst,
HEATING CONTRACTOR
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Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
t ELECTRIC CONTRACTOR
Electric Servo New 0 Change 0 Temp 0
Type
Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
PLUMBING CONTRACTOR --1J J-hLnso n
_BT -LWH
iLav _Sh
iwc -LFDr
~Sink _LTub
Other I ~(la 0 1t bJJ-&
_SP
_Ur
_ CBasin
_ San. Sewer
_ Storm Sewer
~
_Disp
_ WSoft
_OF
_OW
_ Eject
__SS
_ Water
FEES: Valuation $
/
Permit Fee Paid $ ;:L ~ o. C, . ./
Date y~ - :7 y::
.,.2.
Park Dedication $
Final/O.P.
ISSUED BY
perform all work pursuant to rules governing the described construction.
In the perform an
SIGNATURE
AGENT/OWNER
DATE
ADDRESS
TELEPHONE #
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ADDIESS
cm1ER
NA'!tJ1lE
nlOO'J:# ?9?g/
BEP AIR
SAN SEll
wAtER
SPECTION
DATE:
msn en OR
])Am
F' 1/;; ~/7 y
** Violation notes on the reverse sidel
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