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CITY OF N° 39078
n _ OSHKOSH
PERMIT APPLICATION AND RECORD
TYPE: B�DG ❑ HTG ❑ ELEC ❑ PLBG � SIGN '
❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS PLAN NO.
OWNER �D � �. �Q,//� c..Lll.(/�' /�(,/�� •
DESIGNER
USE/NATURE OF WORK _ �1-��� n� �L�
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
PLUMBING CONTRACTOR .�GLYYI/�}�d�YL�
—BT �WH Disp —WSoft —CBasin /�
—Lav _Sh —DW _DF _San. Sewer
—WC _FDr _SP —Ur _Storm Sewer
—Sink _LTub —Eject —SS _Water
Other
FEES: Valuation $ Permit Fee Paid $ �d'6 U 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.
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SIGNATURE � v \ "� •�19� 9�
AGENT/OWNER DATE
ADDRESS
TELEPHONE#