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CITY OF OSHKOSH N° 44739
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 3': ee,
�' PLAN NO.
OWNER R4ND9 1A) &C ' W EP -7 t
DESIGNER , I
USE/NATURE OF WORK ( �� 1 �S 1 AL-� Ji P(4 L G'
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BUILDING CONTRACTOR Se E • ."--
Size Sq. Ft. # Rooms # Stories Height A.217:-.)
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
_ Lay _ Sh _ DW _ DF — San. Sewer
— WC _ FDr _ SP _ Ur — Storm Sewer
— Sink _ LTub _ Eject — SS — Water
Other
FEES: Valuation COf 1::::1 Permit Fee Paid $ .3S QC2 Park Dedication $
ISSUED BY - Date 5/ �� Final/0.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
1
SIGNATURE ! _I , v . _ _ 1 n."NoA - 5' 6
hh I� AG NT /OWNER /) DATE
P_ 1�
ADDRESS )Q t 4' x 7/ f A /� a.. K e sc 1_ £4J i S 7 4// / 3 Fe - 1,9 / e"
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