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CITY OF OSHKOSH N° 14228
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG 12 ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS 7` O Cv� nJ Lf�at PLAN NO.
OWNER ka N L° vi A e c k e- tcI
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DESIGNER J�( �/f
USE /NATURE OF WORK / i /7�/� 1-
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories' Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR (2�'rj'171d 5 52°_ ki (5 Q'�E� �' k1c--
Heat ❑ A/C I� Vent ❑ Fuel /System Elec- Heat Loss _4 Y-t 7' BTU'S ' "
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
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FEES: Valuation $ '/ 3 i ✓ v� Permit Fee Paid $ 7 r. Park Dedication $
ISSUED BY / Date t /9 f 9 Final /O.P. 7// 6 5 9
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE�`� ∎ �_ ��V I O
GENT /OWNER C! � DA E ��
ADDRESS �` 1' ���p �t.�'
1 TELEPHONE #