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� `CIYY OF OSHKOSH
PERIVIIT AP�LICATION �4N� RECORD
��y
N° 39�02
TYPE: BLDG�HTG ❑ ELEC ❑ PLBG ❑ SIGfV ❑ ZONING �.� FLOOD PLAIN , HEIGHT�
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ADDRESS sr�C� � �{ � PLAN NO. ��'-��� �� �
OWNER
DESIGNER
�
USE/NATURE OF WORK
BUILDING CON7RACTOR C �-c �"f l�t E' � ��� �`C�.��e,h� � �� °'� �
Size[P�'x��� Sq. Ft.� �� g # Rooms �-�� �`�� # Stories Height p !��
Foundation �f+-d'"�'� ��'��� uDa��� Class of Const. Occupancy Permit
NFATW(� [`nNTRAC'TOR �ac�`u'.I�_
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
FI FC`TRI(` C`(�NTRAC'TnR � D�/�!�
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
_ BT
_ Lav
_ WC
— Sink
Other
FEES: Valuat
ISSUED BYa
_ WH
_ Sh
_ FDr
_ LTub
- - •--
In the performance of this work I agree to
SIGNATURE
ADDRESS
— Disp
_ DW
— SP
— Eject
'Per 't ee Paid $ _
' Date
— WSoft " — CBasin
— DF — San. Sewer
— Ur — Storm Sewer—
_ SS — Water
/ _ � ;
�� Park Dedication
� Final/O. P.
all work pursuant to rules governing the described construction.
AGENTlOWNER
s����-;
Cq� �— �
DATE
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TELEPHONE #
�-� - .�-s--� �y
OT�VL�TER �� � � ADDRESS_ f b�Z� � � s,
DATE� `� � PERl4IT # ` � USE C����
C��-4. . WoYk consists of �-���"r�s'' ��i,
GENERAL CONTRACTOR
MASON .CONTRACTOR � ZONE � �a.� �
Width of lot DATE INSPECTIDNS
REI�SARKS '
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w
0
r
y
O.
m
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Front of lot MAILZNG ADDRESS