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CITY OF OSHKOSH N9 33459
PERMIT APPLICATION AND RECORD
TYPE: BLDG K HTG ELEC PLBG SIGN ZONING r`'q FLOOD PLAIN HEIGHT
ADDRESS Z Si C
PLAN NO.
OWNER ,71-- B1C -AA
DESIGNER
USE /NATURE OF WORK/iY/ le i d,c 1 -r 0
BUILDING CONTRACTO /71 i1
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. U Occupancy Permit /(1
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
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
t/
FEES: Valuation 6 6 -0 0 57 Permit Fee Paid O C Park Dedication
ISSUED BY�Z��G:Z&A" -y Date V (51/ Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE lt—k—&11&d
AGENT/OWNER DATE
ADDRESS
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