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CITY OF OSHKOSH N° 40292
PERMIT - APPLICATION AND RECORD
TYPE:
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BLDG ❑
HTG Vp ELEC ❑ PLBG ❑ SIGN ❑ ZONING
FLOOD PLAIN HEIGHT
ADDRESS
9/�
72z/' baa/ -` c—/ --
PLAN NO.
DESIGNER
USE /NATURE OF WORK rT / �4-
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR Q -S h'l d 9S �!1 t! � � � C"' 9
AHeat ❑ A/C [P Vent E] Fuel /System Heat Loss AEU � EE BTU'S &` l�7 C–
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
— Sink _ LTub _ Eject _SS — Water
Other
FEES: Valuation $ 46 Permit Fee Paid $� ` �U Park Dedication $
ISSUED BY Date T/L'9/9Z Final /O. P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER
ADDRESS S
\�
DATE
23 5--- �
TELEPHONE #