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N2 39238
CITY OF OSHKOSH
PERMIT — APPLICATION AND RECORD
TYPE: BLDGTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ' L-1\12---- Qt cf L PLAN NO.
OWNER —� � ^C tattc-S
DESIGNER
USE /NATURE OF WORK e- - at- L° - JI • 1 :4 , , r
t e (a.,,. "ar 2c, S c t -LA vents"
(= it r`C4._
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
__Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation �;a»
�j Pe mit Fe- P.id $ � Park Dedication $
ISSUED BY l � �/ .l. /'. -- -_ � ,A, Date -- 7 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE v /'��2 ` ✓- /A[rG' f /P
AGENT /OWNER DATE
ADDRESS .T y y . 414-.- 2S 1"^ c)
TELEPHONE #