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CITY OF OSHKOSH N 42588
P ERMIT - APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS C PS - F�, Cl-/O PLAN NO.
OWNER E/Z , f »!°l /0 JOL/
DESIGNER
USE /NATURE OF WORK _ +ter O(/63C 6/5' N6 / — s%Aya
or SH//tot‘e-6K
BUILDING CONTRACTOR u x '
Size Sq. Ft. # Rooms # Stories / Height y�
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 $ – ••`' Park Dedication $ --- Permit Fee Paid $ a)(
ISSUED BY /l" . Date t/ /1c/OY -
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ,,''
/ 4
'' / AGENT /OWNER DATE
ADDRESS et/ P2� ii171 v 'Tow d r, /?f/Ur/7 G( // ,3/- 9/d
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