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CITY OF OSHKOSH N 46783
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG / SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS /0 5 . .&4AJE PLAN NO.
OWNER l t a SC iC ' CrYLQ I) j,( YI /b('e
DESIGNER
USE /NATURE OF WORK zn15 /D PLUMP)! AIG
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 � "&"01, ii2
a BT WH _L Disp _ WSoft _ CBasin
3 Lav Sh DW _ DF _ San. Sewer `'
3 WC 1_ FDr SP _ Ur _ Storm Sewer
Sink• Jittd LLTub Eject SS — Water
+ Other I . p
FEES: Valuation $ ) • Oh Permit Fee Paid (U . 0O
$ Park Dedication $
ISSUED BY Date g T /.-'_SS— Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
DATE / _ 1^-
EN /OWN �J
ADDRESS
TELEPHONE #