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CITY OF OSHKOSH N°- 38117
� PERMIT -
APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG� SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ��l "�
PLAN NO.
OWNER G
DESIGNER
USE/NATURE OF WORK � - `����
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Ciass 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 _ isp WSoft —CBasin ��/
—Lav —Sh _DW _DF _San. Sewer
—WC _FDr _SP —Ur —Storm Sewer
—Sink _LTub _Eject _SS _Water
Other
FEES: Valuation $ T S� � C' Permit Fee Paid $ �� � �� � Park Dedication $
ISSUED BY � Date � � � Final/O.P.
In the pertormance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE � - � ZL L_ �
AGENT/OWNER A7
ADDRESS �3`� P�.�uS S?' 23S y���
TELEPHONE N