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CITY OF OSHKOSH N -° 34949
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG/ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ! -� 'o PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK i . C
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 k &- 8-•-ti-
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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 $ / .•0 ° 00 7)0 s ®d / Permit Fee Paid $ / > Park Dedication $
ISSUED BY Date V/5/52---Z
Final /O.P.
In the performance of this work 1 agree to perform all work pursuant to rules governing the described construction.
SIGNATURE -
g r
AGENT /OWNER _ /t _
f DATE
ADDRESS 1 a) t� t V e)). -.M.. —Pi- a, 7'..7''‘7't 7
TELEPHONE #