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CITY OF OSHKOSH N2- 41364
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC [� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /0 9' " W D ' ' PLAN NO.
OWNER ezte..4-a4.4. i icAot„,s-
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 j J e i t - L l.‹.- / /7-e .cJ��y+z i
Electric Serv. New, Change ❑ Temp ❑ Type y //q1 Volts3 a) AmpsZ4 c
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 2-67 0 ° ' O ° Permit Fee Paid $ CP *1 — ` °° Park Dedication A n $ 7
ISSUED BY Date J Final /O.P. ` ` I f
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 #
r l
FERMI T NO. 5 . APPL . DATE — 7/2 s//
Q
ELEC. CONTR. / A('4- +-mg-rrv7
OWNER eitt-e-tot
ADDRESS /O Va % 64 , y -,
NATURE OF WORK
ELEC. SERV ( EEW7 CHANGE TEMP
DESC. TYPE ti/e-, VOLTS > AMPS 2-0
FIX' SW'S / .3 AMPS RECEPT'S CIRC'S
APPLIANCES
IGNS
NSP . ROUGH N
ES . COST (o • ,o • O ° PERM T FEE N:-..A0 DATE PD.
REMARKS