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CITY OF OSHKOSH N°- 33210
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC12 PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS I52$ Aq T . V L E/VOA) PLAN NO.
OWNER ROA) POW=
DESIGNER
USE/NATURE OF WORK
3 l0 D. 3 —/erQ
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 42,12:u
Electric Serv. New ❑ Change [Temp ❑ Type /0 Volts' " Amps/C)
6E)-------
Fixtures Switches X Receptacles ,7 Circuits x
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
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FEES: Valuation $ -5 Permit Fee Paid $ 3 ` Park Dedication/$
ISSUED BY Date 3 —3 '' Final/O.P. I — 2-7- 9''
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Aji\M 54-0 rO
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
PERMIT NO,
APP • SATE
ELECI ONTIØ (/)/01 ".
ADDRESS /5a 3
NATURE OF WORK
EC. SERV. NEW CHANG TEMP.
DESC. TYPE" �� - 0- 3 Al,"' VOLTS / - y-e AMPS /
FIX' S SW' S RECEPT ' CIRC' S
APPLIANCES V
SIGNS C "7.s,
INSP. ROUGHIN SERVICED/- /-21 ` Y3 FINALI /7-91
EST. COST �7} O� PERMIT FEE ._)5°DATE PD3-)0 93
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