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CITY OF OSHKOSH N° 14772
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG jy SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS -40r-. `► _ ^ PLAN NO.
OWNER 4C 1
DESIGNER
USE /NATURE OF WORK ,S-Pit-ci 44.N—el CivCi
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 J /Vi./t_ <1 (Cl e., c- i
BT WH Disp WSo? CBasin
Lav Sh DW DF / San. Sewer
6 / °I- --‘
W C FDr SP Ur Storm Sewer
e. Sink LTub Eject SS 4_ Water / l e�—
Other (/ `
0-0 j a
- /
FEES: Valuation $ �s Z50 Permit Fee Paid $ d ` = " Park Dedication $
ISSUED BY z'� Date 7 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /�- eh `� Vi t �11■._
/ AGE T /OWNER 111 DATE
ADDRESS
TELEPHONE #