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CITY OF OSHKOSH N2 39293
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ) 3&) JLWd ) PLAN NO.
OWNER YK 1 %A✓l,y - n a. A,
DESIGNER
USE /NATURE OF WORK 1 _ ,/ /. 4 `
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 p Circuits
PLUMBING CONTRACTOR Pew n1 u4J
1 BT — WH — Disp WSoft ____ — CBasin
Lav Sh DW DF
San. Sewer
WC — FDr — SP — Ur
—Storm Sewer
Sink — LTub — Eject _ SS
Other —Water
FEES: Valuation $ 7. O J
Permit Fee Paid $ 1IP •
0 D Park Dedication $
ISSUED BY Date Jam/ 1/ Q 4
Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREA
AGENT /OWNER W ��
DATE
ADDRESS
TELEPHONE #