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CITY OF OSHKOSH
No 39231
PERMIT — APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 7/ES
/ Pt4o�0 .09,:r of C1 PLAN NO.
OWNER k, v - e . 7 C4 Ce [d
DESIGNER
USE /NATURE OF WORK 5 I �- 1 L"CpP ® F_CC(' )Cr 1 6f -(�` P. /A 7
Ill t�' c., c i- /e
BUILDING CONTRACTOR r� L!'`cx ) ejoyti.� I - r
Size Sq. Ft. / /!/ # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR r
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR r-----___'-
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
FEES: Valuation ! _ ,r
/� rmit /Paid $ Park Dedication $ -.
t/ l i /r► . / 7
ISSUED BY
IV i
----- SAPSe Date F Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE _.- 3 /�
�jJ , / T / OWNER ` DATE /
ADDRESS "! / iC W �- `'6i c2 �/ -� 7
TELEPHONE #
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