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PERMIT CITY OF OSHKOSH N°_ 28793
MIT _ APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC U'I PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS < (r mayr,e_Aw_ NO.
OWNER NA) X/413-2ei
DESIGNER
/ 9/ USE /NATURE OF WORK a40.
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 �" oy / i l . i c
Electric Serv. New
❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles y'
P 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
Oc. /ppc
FEES: Valuation $ J— Permit Fee Paid $ ! !/ Park Dedication $
ISSUED BY /L 1 4 I , Date — 7— -)--- '2 Final /O.P. — -- - 2Z�
In the performance of w. rk I agree to perform - ork pursuant to rules governing the described construction.
SIGNATURE 14 �
AGENT /0W (ER ,C_._..,Z_Z_5±s Z,
DATE
ADDRESS
TELEPHONE #
PERMIT NO. 7 7_ _ APP . DATE > 7 y
ELEC. CONTR. / G-'L - ,
OWNER [Z 2Va--
°
A DRESS _____r ^ ZC '
NATURE OF WORK
C. SERV. NEW CHANGE TEMP.
ESC YTYPE VOLTS AMPS
FIX'S SW'S ( RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL F 42
EST. COST _ D 'r, � PERMIT FEE / f1.--=, DATE PD.S 2 -
REMARKS