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CITY OF OSHKOSH
PERMIT APPLICATION AND RECORD N 42569
TYPE: BLDG HTG V ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS Y/ w/L e_ 4 t✓( wa PLAN NO.
OWNER
ii.jC-4 e_CSWs
DESIGNER
USE /NATURE OF WORK H f`N
�.c' -C,Q/ 11�J2
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR a�` L° (U er y�
e Heat y) A/C Vent Fuel /System �E 0° Heat Loss 743 ripp BTU'S 00
Ar
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 AC e )1 e Permit Fee Paid $0 411.42 Park Dedication
ISSUED BY �efi Date /Berr Final /O.P. ci2 /95
In the performance of this work I agree to 'erfor ork pursuant to rules governing the described construction.
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SIGNATURE i /1S/SY
4part„ AG T /OWNER DATE
ADDRESS
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