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CITY OF OSHKOSH N°_ 33807
` PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG VELEC PfXPLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS % 3 FA ed Pie c, le PLAN NO.
OWNER J"oh v o'xot.�P"
DESIGNER
USE /NATURE OF WORK _ Sew u t` c -e,
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System
# Rooms
Class of Const
Heat Loss
# Stories
Height .
Occupancy Permit
BTU'S
ELECTRIC CONTRACTOR DO 46c a t�
CP
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 $
Permit Fee Paid $
/ L/r
Park Dedication $
ISSUED BY
Date •�
—� -Z - J
Final /O.P. 5 �Z
In the performance of this work I agree to perform all work pursuant to rules governing the
described construction.
SIGNATURE
[�l.e�
S — 12 ` y3
AGENT /OWNER
DATE
ADDRESS
TELEPHONE #