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CITY OF OSHKOSH N ° - 35609
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG t if SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS �� 2, ~/
1� PLAN NO.
OWNER ./
DESIGNER
USE /NATURE OF WORK nr/fl
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 //1
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 $ Kl 0 0 Permit Fee Paid $ ‘ 6 ' 0 O
Park Dedication $
ISSUED BY g�.�
Date ,-- Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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1.
SIGNATURE ■ l
i 3
0 T /OWNER DA
ADDRESS � 0 ° �4&,.y L )_"3600
TELEPHONE #