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CITY OF OSHKOSH N°- 33031
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC [ LBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ..'2'- ZQ v
PLAN NO
OWNER .
?� - �
DESIGNER
USE /NATURE OF WORK - d P'
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 L ■- Switches ' Receptacles ---- Circuits "--- O
PLUMBING CONTRACTOR
- BT _ WH _ Disp — WSoft _ CBasin
- Lav _ Sh _ DW _ DF _ San. Sewer
— WC _ FDr SP Ur Storm Sewer
— Sink _ LTub Eject SS Water
Other
O .i p G _ _ _ _ _ . , . . 4 — — -- — - - — —
FEES: Valuation .`i ----'— Permit Fee Paid $ / Park Dedication $
i
ISSUED BY 1/4/11E..-1..----.... _ Date 3 '3 F /O. P. r' /lo `/
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /� f
AGENT /OWNER DATE
ADDRESS ///
p
TELEPHONE #
PERMIT NO. 3 0 v / . APPL . DATE
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ELEC. CONTR. .g/ /e.ekkei , �
OWNER
73 V _-
ADDRESS o V -
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S - W' S.RECEPT' S
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL (O
EST. COST '00 � � PERMIT FEE /S % DATE PD ° 5-9Y
REMARKS