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CITY OF OSHKOSH N 37350
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELECJ PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 4 7 4 /i, I PLAN NO.
OWNER
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 C...6-r Cry.
Electric Serv. New J Change El eT mp Type 04 Volts 3 Cc) Amps
Fixtures Switches ,R9ceptacles 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 -2O 0 D 0 Permit Fee Paid 5 0 Park Dedication n +I
ISSUED BY G t:..� Date /27/3 Final /O.P. 110/q
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 4 6
/AGENT /OWNER DATE
ADDRESS
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