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CITY OF OSHKOSH
N2 38106
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGAI SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 /1' 7 PLAN NO.
OWNER /'$ .6
DESIGNER 4/ USE /NATURE OF WORK 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 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
FEES: Valuation $ 2- 3 ®- 6 Permit Fee Paid $ ®' Q c ' '� Park Dedication $
ISSUED BY e/ Date 2///7 T — Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE D ,,,, r GL.,itzf f .,),.. 2,,„ AGENT /OWNER DAT ',Li
ADDRESS 1 3 2 E1 T'oi„ t S ST "Z3,S = c[r7 4
TELEPHONE #