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CITY OF OSHKOSH N- 40204
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ^ HTG [~ ELEC ^ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS /' L v ~ ~' y ~ ~~ ~ PLAN NO.
OWNER ~2~ L!~ nOCGL f~ /''
DESIGNER
USE/NATURE OF WORK C--
BUILDING CONTRACTOR
Size Sq. Ft
Foundation
# Stories
Height
Class of Const. Occupancy Permit
HEATING CONTRACTOR %'~~~~J !~~? l ~~ j"" ~ ~_L'I ~
Heat ,~ A/C ~ Vent ^ Fuel/System ,!~-~°• Heat Loss ~1P1''~~ BTU'S ~ ~~
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT _ WH _ Disp - WSoft - CBasin
Lav _ Sh _ DW - DF -San. Sewer_
- WC _ FDr _ SP - Ur -Storm Sewer
LTub
Sink Eject SS Water
- _ - -
Other
FEES: Valuation $ ~/' ~~~ U`0 Permit Fee Paid $ ~~~" ~~ ~ Park Dedication $
ISSUED BY Date ~~~~~ FinaUO.P. ~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER
ADDRESS
# Rooms
9N
TELEPHONE N
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