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O CITY OF OSHKOSH N°- 37782
~' PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC ^ PLBG ~]' SIGN ^ ZONING FLOOD PLAIN HEIGHT
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ADDRESS ~ ~ v /t 1 r !c W~ 0~ ~ PLAN NO.
OWNER ~-'Le- ~t'J't ~'1 ~ ~u,y~,{
DES
USE/NATURE OF WORK J1 .[ /'~ Ptt"
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft.
# Rooms
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System
Class of Const.
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ^ Change ^ Temp ^ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ~ Ya WI I~YLf~~
- BT ~ WH _ Disp WSoft _ CBasin
-Lav -Sh DW
WC - FDr - SP
-Sink - LTub Eject
Other
- DF
- Ur
# Stories
-San. Sewer_
-Storm Sewer
SS ._ Water
b ~O
FEES: Valuation $_ ~~• Permit Fee Paid $ 1 ~ ~ Park Dedication $
ISSUED BY ~ Date ~liinal/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
DATE
ADDRESS
TELEPHONE ~
Height .
Occupancy Permit