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CITY OF OSHKOSH N °- 39071
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ( ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ,1 7,/' / vidoc k • PLAN NO.
OWNER J v lI C )za4 /
DESIGNER ��fJ ��,,,/QJ
USE /NATURE OF WORK �� ' WC--- 7-r:
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR S 7`_' Q1 1 5 004 .>"*A. r" .es
Heat ❑ A/C Vent ❑ Fuel /System
,le cr Heat Loss L, i fit BTU'S 1 �� A 6VC—_
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 $ Permit Fee Paid y- U`e2 I Park Dedication
ISSUED BY / $
Date J /� Final /O.P. � 4' - -( - i Z
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
i viii
SIGNATURE i ' , /1Ji� _ /.75
AGENT /OWNE DAT J
ADDRESS /ol A Z , A A/ E
TELEPHONE #