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O N~ .39175
n CITY OF OSHKOSH
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS SD C~r~,za.4',~~
PLAN NO.
OWNER ~ • ~_~~/~el~iC~'
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
# Rooms # Stories
Class of Const.
Height
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change ^ T mp ^ Type N ~ Volts -? SdL Amps ~ `~
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
-BT - WH
- Lav - Sh
- WC _ FDr
Sink - LTub
Other
- Disp
- DW
SP
-Eject
- WSoft
- DF
Ur
SS
- CBasin
-San. Sewer_
-Storm Sewer
-Water
FEES: Valuation $ FOOD - O O Permit Fee Paid $ S~ ~ O ~ ~ Park Dedication $
ISSUED BY Date ~ Final/O.P. ~I •J~• 9~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TELEPHONE #
Sq. Ft.