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CITY OF OSHKOSH N ° - 38267
(4-11-1) PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS t3 ' (/ PLAN NO.
OWNER . 7 "-- (1- -- )-7---
DESIGNER �A /
USE /NATURE OF WORK ‘ G/� / / /
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
PLUMBING CONTRACTOR 1(
BT W H Disp WSoft _ CBasin
Lav _ Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation $ = ,9 d - cJ c9 Permit Fee Paid $ /6- 6 4' Park Dedication $
ISSUED BY HY Date 7
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
X, ."7 �Y " "` " Aq /OWNER
DA
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ADDRESS
TELEPHONE #E