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N2 37698
411) CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG X SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS I iG.2 `l' N NO.
OWNER /t fI LA 0 4 a .�Gi„ i�.
DESIGNER
USE /NATURE OF WORK /JS1K (/iri L pl
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 NJ mnim4.
BT WH Disp WSoft CBasin
Q.__
Lav Sh DW DF San. Sewer 7
Pi/C
WC FDr SP Ur f Storm Sewer LJA/C
Sink LTub Eject SS Water /CA,
Other
FEES: Valuation 24 O Permit Fee Paid 3
C Park Dedication
ISSUED BY Date 1�' //I Final /O.P. 9 3'73
o /.g
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE j
AGENT /OWNER DATE
ADDRESS
TELEPHONE
C.-a Wg .0
�s I APPLICATION
ADDRESS 1Lia DATE 4'3 PERT# .7l` g
OWNER i� t I. a
NATURE OT WORK /r s 0 1
NEW RELAY REPAIR cos EIOR
SAN SEW qt1C
WATER /C Bathtub Sump Pump
SSQBM SEGT avator9 Ejector
Toilet Water Softener
INSPECTION DATE INSPECTION DATE Kit. Sink Drinking Fountain
s5 Waterheater Slop Sink
,Shower Grease Trap
Floor Drain Local Waste
Laundry Tub Site Drain
Disposal Laundry Standpipe
Dishwasher Catch Basin
Violation notes on the reverse side(