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CITY OF OSHKOSH
Nay PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG Rft SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 ?c 77c7a-P-c— PLAN NO.
OWNER C _M-14 a COY
DESIGNER
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USE'NATURE OF WORK - IV „, Art /At', � r _ /I 4: ',I �
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BUILDING CONTRACT
Size t i Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ ; Vent ❑ Fuel/System Heat Loss BTU'S
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ELECTRIC CONTRACTOR
Electric Serv. N e w ❑ Change ❑ Temp
F � P ❑ Type !" Volts Amps
Fixtures Switches Receptacles Circuits
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PLUMBING CONTRACTOR .,i,:.4 / 9
_ ST WH _ Disp — WSoft _ CBasin
3. Lay ° Sh _ DW . DF _San. Sewer 6 << f r 6-
5 WC FDr __L SP -- L. Ur I Storm Sewer /5 41 PVC-
Sink / `` '
-f-- �' i LTub — Eject SS Water 4 19 /t
Other /— /lu4 ,k4, .4 /- AYcr.„ L v4/ /v 2- l�'.lat oc., /7 f 1/4u
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FEES: Valuation $ Permit Fee Paid ✓ Park Dedication $
ISSUED BY Date / d.--6" Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR f it a - LL ♦ � , - 0 s33D
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AC r 'I/OWNER DATE
ADDRESS •
TELEPHONE 1