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CITY OF OSHKOSH N 36179
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG IN) ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /I? 0 Qa fe 11 PLAN NO.
OWNER S>f'c CA01 Y? AArt 5 m1 W11,
DESIGNER 11
USE /NATURE OF WORK H`v 4.c---, f'r C.// f 4m e.
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR 1 C%L-[J U° r j
Heat ry A/C Vent Fuel /System !V -a._ Heat Loss P5 r BTU'Sdfi
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 33h G49' Permit Fee Paid 4 ff Park Dedication
ISSUED BY i��' Date f`/ t', Final /O.P. ,.5
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 4 10& r 9
AGENT /OWNER
ADDRESS C 0? 50/..21E gifit Os ✓s CIakce"JV I Oa ,0=, .Sa Z" ad `L
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