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CITY OF OSHKOSH
N 42568
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG V ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS II e- b ',god a L9f% W y PLAN NO.
OWNER a c.' L! ee a
DESIGNER ��r
USE /NATURE OF WORK /J 4 `4 t LoGV i4,
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
st HEATING CONTRACTOR 19 H 1 L(J e r 0
Heat 0 A/C Vent Fuel /System Heat Loss ii S' MR, BTU'S trc G
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
FEES: Valuation 31 Permit Fee Paid d. Park Dedication
ISSUED BY C Date V Final /O.P. "r L 9
In the performance of t 's work I agree t perform all work pursuant to rules governing the described construction.
SIGNATURE 11/
AGENT /OWNER ATE
I I
ADDRESS TELEPHONE