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€1:D1 CITY OF OSHKOSH N° 38760
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC,' PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 .t _1 PLAN NO.
OWNER 44.2c4-
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
1
ELECTRIC CONTRACTOR 6G6�7i -60'1 4-te -u -a—c--
Electric Serv. New
X Change l Type y/ Volts 3 u- Amps P
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 O t Permit Fee Paid J 0 0 Park Dedication
ISSUED BY t r./.0 Ge Date W%* y Final /O.P.
L.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
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