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NA ADDRE- S OF WORK p,NGE S
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FIX` S � FINAL __�-3.,�`
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PERMIT FEE
EP- COST ..
R MARKS
CITY OF OSHKOSH N°_ 13511
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECKPLBG ❑ SIGN El ZONING FLOOD PLAIN HEIGHT
ADDRESS J(4, A 1T . (I l-K,i C( _ PLAN NO.
OWNER / /-1 1--O(
DESIGNER
USE/NATURE OF WORK li /C---
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
i
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
2)----------
Fixtures Switches c_----- Receptacles Circuits c/-
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
FEES: Valuatio U Permit Fee Paid $ �U
� Park Dedication $
ISSUED BY ' #`� -2 Date 5 .--.2 - 77 Final/O.P. 5 Q2--7,9
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 0 . .
AGEWAVAINER DATE
ADDRESS
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