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CITY OF OSHKOSH N2-41990
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG j3t SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /3,9 U. -efs (St, PLAN NO.
OWNER 1 I l .11 S _
DESIGNER
USE /NATURE OF WORK . 412.1 ! • 1 9- • ■/ II L I 1 f • . ASIA 1 . /// 0
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent El Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New El Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR 210110JY)
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 $(U) . Permit Fee Paid $ • Park Dedication $
ISSUED BY Date 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 #