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CITY OF OSHKOSH N9 38004
4' PERMIT - APPLICATION AND RECORD
TYPE: BLDG /�J HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ERn )O /2ERJCCDD -/ie+ PLAN NO.
OWNER O6k/ D► V / S
DESIGNER USE /NATURE OF WORK 4IV — 7 � fiC, /iVSUe
_ 1 A . /t6 .._d i arr . ''' v • 0. S G 4 0 (7 70/U
"°Cr/(Dil)„
BUILDING CONTRACTOR ADVOC,OP / //1.C.
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
BT WH Disp WSoft _ CBasin
_Lay _ Sh _ DW DF San. Sewer
- WC _ FDr SP Ur Storm Sewer
- Sink LTub _ Eject SS Water
Other
FEES: Valuation 0 ' 0 I Permit Fee Paid $ ,o Park Dedication $
ISSUED BY - 1 Date ' N� Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE y-- 4 z/43/q4/
AGENT /OWNER
DA
ADDRESS 2 9 2 141-Y60n q2.6 -o /So
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