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CITY OF OSHKOSH
N9 38148
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC
X PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3/0 7 A PLAN NO.
OWNER 4,r.O,e./../
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 (:�.e )1...a•.t/ A )
Electric Serv. New ,Change ID Temp ❑ Type 1 67 Volts' 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 $ 0 0 0 • 0 e, Permit Fee Paid $ 5-c) • O ° '/ Park Dedication $
ISSUED BY G E,4y./ ,Q u,46-'rd.✓ Date - y 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. J 3- /YE- --- . APPL. DATE 0 - &Ac6
ELEC. CONTR. ei.& rt (,).t.,-74..- OWNER )44kf/e ?/�,�G{ -p ( i
ADDRESS 3/ D 9 / "J.tc .c.c of
NATURE OF WORK
1 7.1.41 f
ELEC. SERV.(E�� CHANGE TEMP .
DESC. TYPE VOLTS arc) G//4. AMPS J
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN z 2 14 fr SERVICE / X Y FINAlftif
EST. COST .00 PERMIT FEE S a a v DATE PD. Y y
REMARKS
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