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CITY OF OSHKOSH
N2 45382
P ERMIT - APPLICATION AND RECORD
TYPE: BLDG ,TG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 7 . 4e-A-Pr i r--- PLAN NO.
OWNER LE est+ L! L=
DESIGNER / / n /�` /�
USE /NATURE OF WORK S� a � ��/ S / k (
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ti(� te. �a.J C.c.-4A-4-4---r- �.• ., s r / f zs
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BUILDING CONTRACTOR e r /
Size Sq. Ft. # Rooms # Stories �> Height
Foundation Class of Const. g Occupancy Permit �d
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
_Lay _ Sh _ DW DF — San. Sewer
_WC — FDr _ SP _ Ur — Storm Sewer
__Sink — LTub — Eject __SS — Water
Other
FEES: Valuation / � ° 4'� - mit /., Paid $ O -I Park Dedication $ r
ISSUED BY 416" /
-j Date Final/O.P.
416 In the performance of is work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE X a&_: "► v Aft '' .�
NT /OWNER DATE
40001 , AI
ADDRESS 7.-- Pr ,i' ,001 ✓✓ A57r
TELEPHONE #