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CITY OF OSHKOSH N2-47555
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBGA SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS I q05 l I,h,/ ✓LU4r] dr. PLAN NO.
OWNER (ai ,A 1 h j
DESIGNER j��
USE /NATURE OF WORK. P p [XA0- fh 'r ii
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 1 1/
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
I WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation %r�
Permit Fee Paid
6 Park Dedication
ISSUED BY Date Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 4 r l b Q NER
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ADDRESS
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