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CITY OF OSHKOSH N2 37666
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG,K SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 PLAN NO.
OWNER Tit Ij' 4hyr
DESIGNER (//
USE /NATURE OF WORK A .e• U -7
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 irrYL fl 4J
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 $ roo • °o Permit Fee Paid $ I� Park Dedication $
ISSUED BY Date Final /O.P.
o•
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGE OWNER DATE
ADDRESS
TELEPHONE #