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CITY OF OSHKOSH N2-41921
PERMIT -- APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS a-) .5\vid. L 1( J`n PLAN NO.
OWNER kQ/V 019 hmctrn
DESIGNER `,,�
USE /NATURE OF WORK l� JL� 4 ( tQQr
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 �
BT WH Disp _ WSoft — CBasin
_Lay Sh DW DF _ San. Sewer
WC _ FDr SP _ Ur _ Storm Sewer
_Sink LTub _ Eject _ SS _ Water
Other
FEES: Valuation $ 5CD• Permit Fee Paid $ Ip CC), / Park Dedication $
ISSUED BY Date �� jI Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATU
AGENT /OWNER DATE
ADDRESS
TELEPHONE #