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CITY OF OSHKOSH N2
PERMIT - APPLICATION AND RECORD
09763
TYPE: BLDG D HTG D ELEC D PLBG ~ SIGN D ZONING
FLOOD PLAIN
HEIGHT
OWNER
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..23 i) /.tell -"LrEA -
Sft?e r-1-~71
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PLAN NO.
ADDRESS
DESIGNER
4d'./rA,^-, '.t r<:>'H'd"AJ
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
'. Occupancy Permit
Foundation
Class of Const.
HEATING CONTRACTOR
Heat D NC 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
_BT 2WH
~Lav _ Sh
.:2WC 2.FDr
J7nu. H~"" 6)'":1
_ Disp _ WSoft
_DW 2DF'
_ CBasin
_ San. Sewer
_SP
_Ur
_ Storm Sewer
_Sink
Other
_ L Tub
_ Eject
_SS
_ Water
Ie:;. )<.. .s
FEES: Valuation $
ISSUED BY
.I
'7~) oai-t/'
Permit Fee Paid $ 1..::>1
Date t'r - /0 .- ~~
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 i7 ::r..-f E: Lt /4Z~Sj,,' me!:: J(W' ;1#;; d ~,/
J AGENT/OWNER c;7'
g.~ /0 -8f
DATE
ADDRESS
TELEPHONE #