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CITY OF OSHKOSH N2 34644
PERMIT ' - APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS n Q /`Z Q KY?r #c ct PLAN NO.
OWNER X _ I‘l"P iti/47 7Pf--a,tG L°
DESIGNER
USE /NATURE OF WORK i... / + ' - .A /`- o - __■ = / ..Ctge �,,
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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
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
I/FE Valuation ', 0 iytr. rmit , 'aid $ ��~ Park Dedication $
ISSUED BYld_ f • . .'ate_ . a
' - A.■ Z j Date &AC0...> Final /O.P.
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In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE _� V t
GENT /OWNER D
ADDRESS r G 4.7r A ii' ,, a ` -- ):11 -t14
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