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CITY OF OSHKOSH N ° - 3530
46) PERMIT - APPLICATION AND RECORD
TYPE: BLDG k HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 90 9 S I M SQY\ PLAN NO.
OWNER / /7
DESIGNER
USE /NATURE OF WORK SF I G Me- C1 fi �- t}-/\I D - $0 o
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: Valuati, 4)6.
� P: mit Fee Paid $ Park Dedication $
ISSUED BY I 'Of —24/ 3
Date Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
i
SIGNATURE L .. . I .'1, ,. I . . tr/c.V.3
AGENT/OWNER 1
DATE
ADDRESS i. r� ,rtY '�/ _ (9,®LXt 40u, )'t', 43 / 6 96_'
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