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CITY OF OSHKOSH NE 48245
PERMIT - APPLICATION AND RECORD
TYPE: BLDG LHTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ZIP I ' Dl� Fbw•< -C3
PLAN NO.
OWNER 1k��We ��
DESIGN
USE/NATURE OF WORK T �/l 5` -'J)) N.Ls--J- v ∎, 1 t_:, _ k.Ar f- e
v- .. Z. Caws J S ID' Cc- . ,.. c. LN
BUILDING CONTRACTORG°• r '"C, ( V `� lh 1
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. v 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
Lav _ Sh DW _ DF _ San. Sewer
— WC _ FDr _SP _ Ur _Storm Sewer
Sink _ LTub — Eject _SS _ Water
Other
FEES: Valuation $ L i n 0 0 oc Permit Fee Paid $ Q coo Park Dedication $ .----
ISSUED BY 0)127 Date ) 1 —) . --16..---
1 S Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ,� ' ��i /3 � $
AGENT /OWNER pA
ADDRESS 3-t 44.- u 5 r �t� rIv _
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