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CITY OF OSHKOSH N° 44265
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / D a a 4;11. .14 PLAN NO.
OWNER /
DESIGNER �/f
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 /6
Electric Serv. New pr Change ❑ Temp ❑ Type t1A Volt 1 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 $ 0 0 0 • d 0 Permit Fee Paid $ NZ ' Park Dedication $
ISSUED BY Date 3 /Z' - 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 #
6
' Y Zee . APP . DATE Z
PERMIT NO. L
ELEC. CONTR.
OWNER Ill. o/_, -I
ADDRESS /0 /0 vim,-" PG�t� 4ltIL&
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP-
DESC. TYPE u /4 VOLTS , ?€,) AMPS 74
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES �/
SIGNS v
N P . ROU N ER CE 1 4 F INAL A/ tf
EST. COST (f-, o o a ; .r» PERMIT FEE - S'- DATE PD. ' i 9S'
REMARKS
/ ._. / ..