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460) CITY OF OSHKOSH N °_ 40676
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG X SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 as 1 I /YYl fp F+ , PLAN NO.
OWNER VUW
YLO COI r t"1 h o, JAI .0119/ .
DESIGNER
USE /NATURE OF WORK c kkal@Q l.c )C3..�D C r
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 (" k.Sl'105Sf Y1
BT X WH _. Disp _ WSoft _ CBasin
— Lav Sh _ DW _ DF _San. Sewer
- WC FDr __SP _ Ur _Storm Sewer
- Sink _ LTub _Eject _ SS __Water
Other
FEES: Valuation $ ��/ °I) P ermit Fee Paid $ /7) l 12 Park Dedication $
ISSUED BY Date S ` /L'i inal /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ( E_f_4.,,IAA"..... R— H-- I C
X
AGENT /OWNER DATE
ADDRESS
TELEPHONE #