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CITY OF OSHKOSH
' PERMIT - APPLICATION AND RECORD
TYPE: BLDG>e HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING ' ^2- FLOOD PLAIN S _ HEIGHT__ 1_
ADDRESS j CIP-'6-(-4--
PLAN NO.
OWNER ,
DESIGNER
USE�N/k7 E OF WflR �� r.� -A � .. . t - �L i != i� / N, ��� e,�:�. A YE.. / V� �iflP al F
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BUILDING CONTRACT4rArfa' A IC s
Size Sq. Ft. # Rooms # Stories / Height
Foundation Class of Const. Occupancy Perm
HEATING CONTRACTOR r14
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 41414-4----
— BT — WH _ Disp — WSoft CBasin
—Lav _Sh —DW
— OF — San. Sewer
_WC _ FDr _SP _Ur _Storm Sewer
— Sink _ LTub _Eject _SS _Water
Other
FEES: Valua • ' • $ Vi Permit Fee Paid j
$ °�'� Park Dedication $ N�,4
ISSUED B W. A / Date 5- Z / G
,'6 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE fre-e-Z.Z.vs-r./ d ✓C' a I X
/ J71Por-4,-.4 AGENT/OWNER DATE
ADDRESS 9L1 G , az-r 441 ,4",70/ „ ' d /a
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