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CITY OF OSHKOSH N°- 35276
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBGy SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ,"A1 ,X l I 7. (r ,r1 -6:"\,- PLAN NO.
OWNER ,i1 C
J� 4 (7/7,/?/-K)"Z-6,��
DESIGNER
USE/NATURE OF WORK .✓li%-''k' - :A 7\/
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
i ;r
PLUMBING CONTRACTOR �C .'t i y! -c'71..,,1 y�i/f�
BT A 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 $ , .; ( > Permit Fee Paid $ / 0• 1-143
Park Dedication $
ISSUED BY f,//r ��* '�_ ��r1--�! '�;` Date ,,..z. -t+..4,.4-- 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 `--�
NT/OWNER DATE
ADDRESS
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