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CITY OF OSHKOSH N2 45332
PERMIT - APPLICATION AND RECORD
TYPE: BLDGZ<HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS '- e f — PLAN NO.
OWNER V e w t '
DESIGNER ��yy �
USE/NATURE OF WORK c- P I L°- elcr sltk P l°SC L' P�t� •`N
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BUILDING CONTRACTOR • 2 ce..._ Q F l e r
Size/' -- Sq. Ft. '•. / # Rooms ( # Stories ` Height (/ 4 0 peak
r
Foundation tN� �' S Cti f Class of Const. A Occupancy Permit keyr
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 `f•A � Per•2 ee Paid $ Park Dedication $
ISSUED BY =/ /� 4 - —( 1' Date 6 9 _ Final/O.P.
In the performance of th ork I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR � / A
AGENT /OWNER DATE
ADDRESS e 3 a Pope v5' 31- / 3�-2'/
" TELEPHONE #
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