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N9 35851
CITY OF OSHKOSH
PERMIT - APPLICATION AND RECORD
TYPE: BLDG 6ti HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 1l� N1 T ' 0 rte ' J ti PLAN NO.
OWNER \. ALI (-\(�kl E
DESIGNER \ 1,
USE/NATURE OF WORK I`'L1K__,1<X :)-\--Y. \t ' c 1,;\jc)C`'I:, c�\A \(?
LA..." t-yr. " )vt.c Cr<_ . C ,r_s:_P t='L C
BUILDING CONTRACTOR V7/1(...L -Cy pac - 07'r
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
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
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FEES: Valuation $ '-' '�J Gam_8 Permit Fee Paid $ I( " U Park Dedication $
ISSUED BY '.2,4--v-A- 1. t S1 1A1J( Date q/q)(7 3 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
174. � " ; ;i
SIGNATURE 'j;'V .Cis 'Le' . 2_ G U l/" 0� 6‹ cy q– C?
AGENT/OWNER DATE
ADDRESS TELEPHONE#