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CITY OF OSHKOSH N° 28958 }
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PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG [ + ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT-
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O- Y,� �4/'��/�a y/' PLAN NO.
OWNER ra / COC7 fi
DESIGNER
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR 11 h
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Heat E] A/C Vent F-1 Fuel/System Heat Loss j }I r� BTU'S 3 h
tLECTRIC 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 $ �/�/ O`D r dJ O Permit Fee Paid $ 7� 4 Park Dedication $
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ISSUED BY E�-L Date Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER AD TE
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ADDRESS
TELEPHONE#
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PERMIT NO. ff yj APPL. DATE
ADDRESS ] yS� e?h kS' I�f'
OWNER `)a cOOk e
NATURE OF WORK
HEATING CONTRACTOR �u y� Vq L Bl4 y�
FUEL: GAS OIL EC' SOLAR SOLID
C0NDITIONING FORCED AIR H.W. ELEC. BASE STEAM
SYSTEM GRAVITY SUPPLEMENTARY R COND.
CH7MNEY: "A" "B" DIRECT VENT CON. BURNER
CALCULATED HEAT LOSS SYSTEM BTU RATING
MISC.
INSP. ROUGH IN FINAL 2
EST. COST,&ZOO .cy PERMIT FEES ;7e C ATE PD 4Ys
REMARKS