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CITY OF OSHKOSH N2 38812
PERMIT - APPLICATION AND RECORD
TYPE: BLDG .ITG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 2 f O e,ra k PLAN NO.
OWNER Nc r
DESIGNER
USE /NATURE OF WORK IG - r` c r'� /� , ti ->— e� I'e Q k
BUILDING CONTRACTOR &CO l'tC'_I--
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit 4.
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 f .1. ��� Permi a Paid $ Park Dedication $ �—
ISSUED BY ��1r11.� = -� Date Final /O.P.
In the performance of this work I agree t perform all work pursuant to rules governing the described construction.
SIGNATURE - �- I 1
l AGENT /OWNER DATE
ADDRESS a4i(� �� NA SI
TELEPHONE #