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CITY OF OSHKOSH N ° - 38785
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 7 7 0 A C - PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK
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 Cu- 7-7
Electric Serv. New ❑ Change ❑ Temp Type 4 /c, Volts 3 (A Amps 5
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh _ DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub _ Eject SS Water
Other
FEES: Valuation $ 5 D 0 0 Permit Fee Paid $ / a 0 ` Park Dedication $
ISSUED BY �9 .r ' - Date ii/sf/4r Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
6.p
j Y
PERMIT NO. '3 7 S . APPL . DATE f1--/3OA-
ELEC. CONTR.
OWNER l
' ADDRESS /7 fi
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS 3 GO C,/ A-, AMPS SO
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
NSP. ROUGH N SERVICE t o 7 FINAL
EST. COST SO. D 0 PERMIT FEE/0 ,v -' DATE PD. y' ' cF
REMARKS