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CITY OF OSHKOSH N° 33841
PERMIT - APPLICATION AND RECORD
TYPE: BLDG X HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 473 3 ? (/I'J - 2`e ' PLAN NO.
OWNER
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USE /NATURE OF WORK - / ` / « ' . AK��
BUILDING CONTRACTOR #
Size Sq. Ft. # Rooms # Stories / Height
Foundation Class of Const. a' Occupancy Permit ,/0
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
_Lax/ Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation $ 35 S 0. 0 - Permit Fee Paid $ 2- , t d 0 Park Dedication $
ISSUED BY 9.14A-42.44, Date N�3/f1 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
/674-e .3 ` D i "
AG NT /OWNER / D
ADDRESS X 5 73 7 �" (` 3> ._ / J S 7/
TELEPHONE l #