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(1 I -I- I ) CITY OF OSHKOSH N ° - 40302
P ERMIT - RECORD
APPLICATION AND RE
C
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3/ ,5 4 6 f / PLAN NO.
OWNER A /
DESIGNER ,
/
USE /NATURE OF WORK AV Sy" ` 0
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 -- , ,zsc__
BT WH Disp _ WSoft — CBasin , e '
Lay _ Sh _ DW — / DF ! San. Sewer J % 1 n G
WC _ FDr SP _ Ur r Storm Sewer K f9' ck_
_ _ —
Sink LTub Eject SS /
Water l c - c --4- --
Other
FEES: Valuation � ° 3 8- C `
$ S45--05 ^ o Permit Fee Paid $ i Park Dedication $
ISSUED BY � Date e,"7,43/C- Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE / 6 - 27- 7
AGENT /OWNER DATE
ADDRESS e - �-5-4 f-Q .13_s 6 «.SGT
TELEPHONE #
ADDRESS 3/ ....,"f, num.= PERMIT APPLICATION zi
OWNER i - r
,
� DATE ' PERT# 5�c� 0 .Z
NATURE of won s - 0 _ -4: `
.
NEW
_� *'' r Y R=OB
A. sa.�.gr�■ = ■ =- : su .
�� � *Iv ON DA* � m u '.
Ejector P
DATE , Water Softener
t a�i-.7�—
�`= Drinkin • Fountain
S
11117:17.1112 Slo. Sink
vv`'S7-S / D / '�! Floor Drain e-se T a. INSPECTION
/ 1111 Laundry Tu. - Local Waste
1111 Dis.osal Site Drain
1111 Dishwasher Laundr Stand•i.e
Catch Basin
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