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CITY OF OSHKOSH N° 38327
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ( HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS #9570 S6EIOA�
PLAN NO.
OWNER /MI g/t
DESIGNER
USE /NATURE OF WORK /'- • ��0,c> j1' rn (7- (
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BUILDING CONTRACTOR ' OW
Size /I- Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. g Occupancy Permit •
HEATING CONTRACTOR !
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR WUCX
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR WAS
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink _ LTub Eject SS Water
Other
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FEES: Valuation $ .� Permit Fee Paid $ Park Dedication $
ISSUED BY - Al ! Date OM Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATU• _1 z_ ' . ik. _'° _,_ l 3 -/ -7/
AGENT /OWNER DATE
ADDRESS 0 257 0 -1111 L g -gg�,4
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TELEPHONE #
OWNER // M ADDRESS .0 7 O 9; /
DATE X111 q9 PERMIT #g USE .5,
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GENERAL CONTRACTOR 91lj �y 2' consists of V (i �r�C
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MASON. CONTRACTOR ZONE
Width of lot DATE INSPECTIONS
REMARKS
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Front of lot MAILING ADDRESS