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CITY OF OSHKOSH No 42929
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS q 3 1 11 )-(1C 0 kind PLAN NO.
OWNER firt.kW 6,
DESIGNER
USE/NATURE OF WORK MiAtc
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 m YYL�_5
- BT WH Disp _ WSoft _ CBasin
_
Lay Sh - DW _ DF San. Sewer
— WC _ FDr _ SP — Ur — Storm Sewer
Sink _ LTub - Eject SS — Water
Other
/1r1 00 FEES: Valuation $ Permit Fee Paid $ GV • C Park Dedication
c
ISSUED BY Date —7 _ 7 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 #