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CITY OF OSHKOSH N° 35243
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS kJ(' j '/` ti PLAN NO.
OWNER g./2/2y- doe-ilitala.)
DESIGNER /f
USE /NATURE OF WORK �I.P� 2 . 11.27V
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 0 Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR ,,4 f.xt-n/r..Qyt.d
BT ./. Disp WSoft
CBasin C___
Lav _ Sh _ DW DF San. Sewer
WC — FDr _ SP Ur Storm Sewer
Sink LTub Eject SS
Water
Other
FEES: Valuation $ 56o. !!'U Paid $ V
Permit F ee P ��
/ ,��� �� " Park Dedication $
ISSUED BY !/?.).a ��C:e`sC..- �'al',Q,� Date 4E t 3
Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
MO M___Th
SIGNATURE
r - AGENT /OWNER DATE
ADDRESS
TELEPHONE #