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CITY OF OSHKOSH N° 43094
PERMIT - APPLICATION AND RECORD
TYPE: BLDG VI HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 91435*
t I c9 S 1.1E J Sr:
PLAN NO.
OWNER Fa C1-1423 HAS
DESIGNER NIA
USE/NATURE OF WORK Cs RE)■)E ( .m CK * g3SP JO/r?
FIN /S I (NNN6 Of -F Lo i (....61/67.. OF 2/CE -o/u. ,
BUILDING CONTRACTOR cC.c)NER
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. S Occupancy Permit ___EiZ
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
Lav _ Sh _ DW _ DF _ San. Sewer
_ WC _ FDr _ SP _ Ur _ Storm Sewer
Sink LTub Eject SS Water
Other
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FEES: Valuation JO ✓ Permit Fee Paid $ (3O t. � Park Dedication $
ISSUED BY Date to y Q
t S l 1 l Fin I
a /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ID- - /q -q
AGENT /OWNER `` rrtte� DATE
Art t ).5 c5 . • 1 Oshkosh U.LE. 5/4'o/ tog o1-3 -tads'
TELEPHONE #
HERM NO �F3 i . APPL. DATE '
E C. CONTR. / -Ar.c-�
OWNER / .ti ` li AVl a.. / ..�� ' -� 1 3 r 3
4LL
z5 �i
ADDRE S i
NA ' E OF WORK /'L <<
CHANGE TEMP
C. SER N W VOLTS AMPS
lb C. .E
FIX'S SW'S RECEP 'S CIRC'S
ANCES
S
GN
ERVICE FIN
NS'. ROU N 117 PE' T FE D T . ' 9 i M4
ST. COST
R _MARK
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