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CITY OF OSHKOSH
N2 - 46826
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1-3 13 ,"(e, t r-oe SDI— PLAN NO.
OWNER
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DESIGNER �f / `, /
USE /NATURE OF WORK -. ri- .. // �K.S `�'4 /! 34 �QP R .� � e ms , H , i 1
4 14rs P;vier1V -
a_s 4 ,04.11 ).. ti ot-e / 1 . - 1 -Z --.. V is eD e ,,A, e_ed rk
BUILDING CONTRACTOR °`. Ci p
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit . �t?
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR .r+.7 /Ce r--
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR _._C_ g a
_ 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 6 Permit Fee /� ~ J
,`� ee Paid $ "e2---74.___C— Park Dedication $
ISSUED BY 11 Date Final /O.P.
In the performance of thi work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE AX-- cr-
NER DATE
O �� .
�/ i�� AGE
NT /O
ADDRESS / ...1 i , 2./. ., � - p�r a1 a'4
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