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CITY OF OSHKOSH N° 4753
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG 0 SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /83 9 ill nerva iS f . PLAN NO.
OWNER Lill 3 ns r
DESIGNER
USE /NATURE OF WORK a M ale r" )j GL-1 - r
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 m ML Y1 S 1 1 b C� .
BT WH _ Disp `J _ WSoft _ CBasin
Lay _ Sh _ DW _ DF _ San. Sewer
— WC FDr _. SP _ Ur _ Storm Sewer
— Sink _ LTub _ Eject — SS — Water
Other
FEES: Valuation $ Permit Fee Paid $ 10 I Park Dedication $
ISSUED BY Date " - "- - ?--S
5 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Th , <Thc ---- Nr
AGENT /OWNER DATE
ADDRESS
TELEPHONE #