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CITY OF OSHKOSH No 13046
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC "PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS /60 10 WV u /4 PLAN NO.
OWNER M AA k r' 5.t,t) 1C Z_
DESIGNER
USE /NATURE OF WORK 7k
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 S --e.�"
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits c.------- 0) t
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation w Permit Fee Paid w Park Dedication
ISSUED BY P Date o Final /O.P. 2r —7
1
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE y g- J c�
AGENT /OWNER DAT
ADDRESS X
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