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CITY OF OSHKOSH N° 35819
PERMIT - APPLICATION AND RECORD
TYPE: BLDGTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /SS- 7 SC` Se, PLAN N NO.
OWNER �h(epr1 e, 4
DESIGNER
USE /NATURE OF WORK S f>
7
Vela( S ,` ....,._ o
BUILDING CONTRACTOR Nc L -1 "
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 '. - C'-`---& — 'emit F . Paid $ _
:: 1tb0h1 $ / / Ilik
In the performance of is work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 94/ - _ 1 -5
A 9 T /OWNER // DATE
--7/1 ADDRESS S 7Y1 ; 4) 5.--eo b
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