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CITY OF OSHKOSH N2 38765
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC
X PLBG SIGN ZON ING FLOOD PLAIN HEIGHT
ADDRESS Z ii,dIele7 PLAN NO.
OWNER AGed .�CCi
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
4
ELECTRIC CONTRACTOR &G--y9'C liytT /4e-eA J u,erc_-
Electric Serv. NewX Change Tefip Type 4 Volts Amps e/eV
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
I
FEES: Valuation ,P1,9A- 42 0 Permit Fee Paid 5 o. 0 'j Park Dedication
ISSUED BY /44€ 4,- Date y/y Final /O.P. 10
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER
DATE
ADDRESS
TELEPHONE