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CITY OF OSHKOSH N° 39411
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC PLBG,' SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 Sc PLAN NO.
L '_U
OWNER C[is
DESIGNER
USE /NATURE OF WORK /V✓/ Q r
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
Electric Serv. New Change Temp Type Volts Amps
Fixtures Switches Receptacles Circuits
PL UMBING CONTRACTOR /'7
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer c(/I/ c
WC FDr SP Ur Storm Sewer �f
Sink LTub Eject SS Water
Other
0 0 i
FEES: Valuation O O d Permit Fee Paid o Park Dedication
/6
ISSUED BY ��l/ Date /"4/�
X Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR. „5"-- /-2 Sy
AGENT /OWNER DATE
ADDRESS /3 G.) u° 0 9,,¢,2 C m�J,at ,4,L 23.? 2 S-
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