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CITY OF OSHKOSH N246149
PERMIT - APPLICATION AND RECORD
TYPE: BLDG 1TG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /0 Z Air L i.
PLAN NO.
OWNER /1 -1-4— Qw k
DESIGNER
USE/NATURE OF WORK t . rte i /./. , ) A co • • 9 �C .IhP AtkP d /
v Es
BUILDING CONTRACTOR C% el-t bt. e (—
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
— 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 J� CO • : rm paid $ Park Dedication $
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ISSUED BY - . .. 1 �� Date .S Final/O.P.
In the performance oft ork I agree to % orm all work pursuant to rules governing the described construction.
SIGNATURF�.H.� ..-ft Ai I �---
n AGENT /OWNER DATE J
ADDRESS 7 T� 4.4 jJ A3 / Ti 7
TELEPHONE N