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CITY OF OSHKOSH N° 42692
PERMIT — APPLICATION AND RECORD
( AraAg-)
TYPE: BLDG d HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS I / / /' 2Q) 1' AjcAJ
PLAN NO.
OWNER 77-6114S la 1:i s C,j-4
DESIGNER
USE/NATURE OF WORK (Srtcl lorIE Alv AAGvG• cx
t■.JC,LE CM AC-, '.
BUILDING CONTRACTOR RDSCA-k
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
FEES: Valuation $ , 73 t Permit Fee Paid $ 10I� )n Park Dedication $ �`
ISSUED BY /f.. A)* - - - Date ( t l j —f vt L Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 1111 }-__A_- 5/
1 AGENT/OWNER l��
2 j� ) f� D CE
ADDRESS & / 06 l/L-- i73ter, �c" Y/ - 4 ?O3
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