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CITY OF OSHKOSH N 36788
PERMIT APPLICATION AND RECORD
TYPE: BLDG E] HTG ELEC
X PLBG SIGN ZONING FLOOD PLAIN HEIGHT
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ADDRESS /2- 7 k a)4_ PLAN NO.
OWNER d� G .0eit' d
DESIGNER
USE /NATURE OF WORK
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 .._rr�
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Electric Serv. New Change emp Type •r Volts3 Amps O tt
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 2- 0 0 Permit Fee Paid .5 0 0 Park Dedication
ISSUED BY Date /i /9 /f..3 Final /O.P. 4/ ai/ 9
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE I �/L�_ i��s f--, 9 7-
AGy NER DATE
ADDRESS .009'
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