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CITY OF OSHKOSH
N2 35545
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG e SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS // d C 4/ PLAN NO.
OWNER C- i
DESIGNER ,/ Q
USE /NATURE OF WORK i S r- /� - w
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 / / s:
— BT — WH — Disp _ WSoft — CBasin
— Lav _ Sh DW DF I San. Sewer `e v c
__ — __ t
— WC FDr SP Ur I Storm Sewer ( 7 / 1 ) V C
Sink — LTub Eject SS Water
Other
/
FEES: Valuation $ / ,a O 0 • ° 6 Permit Fee Paid $ O s Park Dedication $
ISSUED BY Date IV/Y -I
( /Y (-I Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE `C Q...„ "e' SO?$'Z Y- t1 ^
AGENT /OWNER DATE
ADDRESS �� y � ( - ta¢t„e.„s, 17 - 39 7 S -
TELEPHONE #