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CITY OF OSHKOSH N° 39408
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / .2 PLAN NO.
OWNER AO Ai ��L /i 4
DESIGNER
USE /NATURE OF WORK
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 o /4 / Volts 3 ( d Amps d
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 j9So• D d Permit Fee Paid $ 5-0 d o V
Park Dedication $
ISSUED BY Date 02-A / Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. 3F ADD t . APPL. DATE 3/30,4
ELEC. CONTR. (,.14x
OWNER P4`n i..65.41/1/'
ADDRESS /h -3
NATURE OF WORK
ZLEC. SERV. NEW f a. TEMP.
DESC. TYPE V•LTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGH N SERVICE 1 0 5 h V FINAL
EST. COST 3/S"D• PERMIT FEE s'TJ, of DATE PD.0
REMARKS
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