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CITY OF OSHKOSH
N °_ 45999
n PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG.k''SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS W C -A -) A''-1 PLAN NO.
OWNER _62_e_ 4 /
DESIGNER
USE /NATURE OF WORK
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. J 0.-`n ff
l&IS 7/1 L4-h
hill ( i
BT — WH
_ Disp
WSoft
CBasin
Lav — Sh
_ DW
DF
San. Sewer
— WC _ FDr
SP
— Ur
—Storm Sewer
— Sink _— I -Tub
Eject
_SS
Water
Other
FEES: Valuation $ o Permit Fee Paid $ Park Dedication $
ISSUED BY Date // S Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE � �—
AGENT /OWNER DATE
ADDRESS
TELEPHONE k