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CITY OF OSHKOSH N° 35283
L PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 61 /7 44
PLAN NO.
OWNER /6Z&11 e77`,,hpai..
DESIGNER
USE /NATURE OF WORK J • /_"' .
BUILDING CONTRACTOR
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 Si Thne■--69
BT A WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
— WC FDr SP Ur Storm Sewer
Sink LTub Eject SS — Water
Other
FEES: Valuation $ Sze). OD
P erm it Fee Paid $ / d • Park Dedication $
ISSUED BY ..G _ s _ ' J Date O2 ' / 7 Final /O.P.
`3
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/ ER
DATE
ADDRESS
TELEPHONE #