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CITY OF OSHKOSH N ° - 47587
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG Af SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 9 5 h ore, t o 7 1)r. PLAN NO.
OWNER � � ( ( I DIa r k
DESIGNER i
USE /NATURE OF WORK ('Q, Jk CP UJcaer e 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 ciinmofS P 1 icx3 .
- 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 $ Q 0 Permit Fee Paid $ 1 Park Dedication $
ISSUED BY Date l`® �- Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE . 61
AGENT /OWN DATE
ADDRESS
TELEPHONE #