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� CITY OF OSHKOSH N°_ 32461
�' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 30 D O ���,Q�l,f� (/1- • PLAN NO.
OWNER -- i�-�yC.C,C�1"-U /�d/�' ""�..�tt,GC.
DESIGNER
USE/NATURE OF WORK�,�J %'/�
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_��9�� /✓�/��j'r
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
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FEES: Valuation $ �� ' � v ^ Permit Fee Paid $ ��• � �� Park Dedication $
ISSUED BY Date Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE_ /��C- �, y /`��—9�
AGENT/OWNER DATE
ADDRESS o23/`y�7_�
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