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CITY OF OSHKOSH N °- 43352
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECX PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 /13 ! z9
� p PLAN NO.
OWNER 'r /7-44461-4- ✓-A- , Gt/Y-A ;
DESIGNER
USE/NATURE OF WORK 7 i't" - /-0'j'vt • eh — AX4 , j Xi
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 Q tIh4/4
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 $ 0. DO Permit Fee Paid $ JO -p
1 Park Dedication $
ISSUED BY D ate IAA Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE •114 t AGENT/OWNER
/-. /...T5- 2 // S DATE
ADDRESS 3 'r 3 t3 e 1 P(e M Or y,Z6_ r% y.-L
TELEPHONE #