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47903
CITY OF OSHKOSH �°-
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ►_� ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / V % 51ey PI' cv
PLAN NO.
OWNER /9 rn/7 / Z 5 5
DESIGNER Aid USE /NATURE OF WORK ,6? i '! WC
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR ! - -.
g., F .
Heat ❑ A/C 11§ Vent ❑ Fuel /System �� 4
Heat Loss � / c5 � BTU'S � � �� C
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT _ WH _ Disp _ WSoft —. CBasin
Lay _ Sh _ DW _ DF _ San. Sewer
— WC _ FDr _ SP _ Ur — Storm Sewer
— Sink _ LTub _ Eject _ SS _ Water
Other
FEES: Valuation $ P 7.0v. �d Permit Fee Paid ./ 7 41-r"' $ Park Dedication $
ISSUED BY Date / %y /CC -- Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (4 ). 7 ,,,q, y
,..
GENT /OWNER
/ %yi9S
DATE
c! jcat-C4 ADDRESS ' ` 10 g 3 57--d9 7C
TELEPHONE #