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CITY OF OSHKOSH N °_" 48134
' (41) PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS (Cy r
= PLAN NO.
OWNER • /.
DESIGNER �J/
USE /NATURE OF WORK //" 5/ — \
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
BT — WH _ Disp — WSoft — CBasin ,Q C
_ Lav _ Sh _ DW _ DF ( San. Sewer .. C-
WC — FDr _ SP — Ur r Storm Sewer j i le C
Sink — LTub _ Eject — SS Water (
Other
FEES: Valuation $ / 6"--cn d `c.N 8 Permit Fee Paid $ ®" O 6 Park Dedication $
ISSUED BY Date 11 / 3 Final /O.P.
In the performance - this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE ,1 7 - 9 C
K 14� /A G Z�
AGENT/OWNER , s DATE , /07
ADDRESS 2 ` C � J�Y A] ' 6 '214 d c. 5���� !Of/ �'' r 3 5° 6 7 5
TELEPHONE #