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CITY OF OSHKOSH
N2 44251
PERMIT - APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 0, 0 A(1 0/2E 4 /V4 57: PLAN NO.
OWNER Al nLE P#Q ./ I
DESIGNER
USE/NATURE OF WORK 1 %m' xJ &---- r 4.u44. S N6 ' /L.,S/id e.L
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lkJ 6A/"))/a6G
BUILDING CONTRACTOR LUCE C.4 /5
Size Sq. Ft. # Rooms # Stories / Height
Foundation Class of Const. e Occupancy Permit NO
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
— Lay — Sh _ DW _ DF _ San. Sewer
— WC — FDr — SP — Ur — Storm Sewer
— Sink — LTub _ Eject — SS — Water
Other
FEES: Valuation 7c.D, / - ermit Fee Paid $ 3-� ; ��
Park Dedication $
ISSUED BY •, . . ! : _ / Date 4a 9 /Yr Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE _ ,>._ Y _5
GENT /OWNER l , DATE
ADDRESS -70 ��e.e� - -Ir/�/ �� 9,A-- oD..9,5 d /n kQ
TELEPHONE #