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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
10734
TYPE:
BLDG 0 HTG 0 ELEC 0 PLBG J2F:-. SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
OWNER
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PLAN NO.
ADDRESS
DESIGNER
USE/NATURE OF WORK
~A&A s;(/
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
_BT 1WH
2Lav _Sh
.2- WC -'- FOr
_ Sink -t- L Tub
Other
/h;c c is,
_Disp
_OW
_SP
_ WSoft
_OF
_ CBasin
_ San. Sewer
_Ur
_ Storm Sewer
_ Eject
_SS
_ Water
FEES: Valuat;on $ '5560 -- . Pe,m;t.fee Pa" w~,1~
ISSUED BY ~~7r"------- Date &J/n
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
of-
~~
0Jul~ M P ,330
AGENT. NER
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IO-'-f-~f
DATE
ADDRESS
TELEPHONE #