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CITY OF OSHKOSH No 39679
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC)' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 / / Z
PLAN NO.
OWNER :GZIK Lt
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 (1*-4-7-1-6irr. ' / ) �a
Electric Serv. New Change ❑ Temp ❑ Type 4/67 Volts 3 Amps 0
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: Valuations D Permit Fee Paid $ J"�O•D
Park Dedicatio -* $
ISSUED BY !1� �� i, Date 3/2-7h Final /O.P. J -r.-7 • / ci 7 �1
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. 679 . APPL. DATE 3 / 3 //SY
gLEC. CONTR. a.
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OWNER
ADDRESS - /3
NATURE OF WORK
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ELEC. SERV. EW CHANGE TEMP.
• C. - E _ VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
NSP. ROUGH N SERVICE % I FIN• 7 V
EST. COST Po oo .eo o PERMIT FEE ' O •oo DATE PD. `/4 (
REMARKS
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