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CITY OF OSHKOSH N° 47099
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 .ate' L PLAN NO.
OWNER g/.(, -C ..7
DESIGNER
USE /NATURE OF WORK /,LL4) ?g,-,A.-0-c----
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 MOtI/t-l/
Electric Serv. New X Change Temp Type /67 Volts -3 Amps"
Fixtures S witches 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 3 C Permit Fee Paid OA Park Dedication
ISSUED BY 4 Date l Final /O.P. Vd
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGN J
AGENT /OWNER DA
ADDRESS
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