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CITY OF OSHKOSH N° 42934
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 2- Z / i t-rva 2 PLAN NO.
OWNER (.1 / /
DESIGNER
USE/NATURE OF WORK
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 "7/6-v2./ c G— 200 isti L F
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 $ (P -000 0 4o Permit Fee Paid $ 5-6 . o 0
Park Dedication $
ISSUED BY , 9 �,, Date /2.1/ /f
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER
DATE
ADDRESS
TELEPHONE #