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CITY OF OSHKOSH N° 33217
PERMIT - APPLICATION AND RECORD
TYPE: BLD�TG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1-1 Ale -SCt t• / er PLAN NO.
OWNER 73/ties.._ e_ K-- 1-4._ 1
DESIGNER ,,((' f ,p //fJ /
USE /NATURE OF WORK e -o'er -M f ` t' c P atfl At- Gi4('P / ig e1Ls c•- S S o I''cr°
/ ec4 etici> €' , Co te_ t- Lf---P (Qer /rt ‘ / /
BUILDING CONTRACTOR A i'L
izrr! X If Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. 8 Occupancy Permit �p
HEATING CONTRACTOR '...----.
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR / r tc-t° r
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 9-----
BT WH Disp — WSoft CBasin
__Lay Sh _ DW _ DF San. Sewer
__WC _ FDr _ SP Ur __Storm Sewer
Sink LTub Eject SS Water
Other
1r
FEES: Valuation r. Per -i ee Paid $ d Park Dedication $
ISSUED BY le./_ _ _ 4 r _ A. ii' Date = 0 Final /O.P.
41/4 /
In the performance of this work I agr-e t• perform all work pursuant to rules governing the described construction.
SIGNATURE � `:' �/� � �' I / /e.
/ - AGENT /OWNER DATE
ADDRESS / V•l �C r�i -5 2 -/
TELEPHONE #