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CITY OF OSHKOSH N° 32745
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG ,E] SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS l�' 4-
PLAN NO.
OWNER ....m.c�—
DESIGNER
USE /NATURE OF WORK 4/Sf 6 -,-.---e:-
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 y"'r
BT WH Disp WSoft CBasin ��GG
Lav Sh DW DF San. Sewer J C
WC FDr SP Ur Storm Sewer r L C
Sink LTub Eject SS 4L Water C
Other
FEES: Valuation j OCR O Permit Fee Paid O G Park Dedication
ISSUED BY Date 2 7
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 'y? o7 7 re 3
J AGENT /OWNER DATE
ADDRESS
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