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CITY OF OSHKOSH N ° - 38353
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ; SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 010 lj11
PLAN NO.
OWNER BaAktA, a, 23/4_,A
DESIGNER / USE /NATURE OF WORK A.( ft 40 .41
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
FEES: Valuation $ "7 QW • Permit Fee Paid $ /0 o 6 Park Dedication $
ISSUED BY Date 3/q/94 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE , 0).
AGENT /OWNER DATE
ADDRESS
TELEPHONE #