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� � CITY OF OSHKOSH N° 05771
`' PERMIT - APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING ^' �� FLOOD PLAIN� HEIGHT �% '�
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ADDRESS � °�� � " j N�-^��p �A� PLAN NO.
OWNER �OI-� �J Ct�n�tH r����. M CZ. t-���
DESIGNER
� I�JC.._L�*. � S'�4+�1C�5c.
USE/NATURE OF WORK t�u
BUILDING CONTRACTOR�V`AC �� S[K�r -i.i�oJ1A /V�,�S
SizeZ� k�J � Sq. Ft. � # Rooms # Stories Height �s
�� �J� �c.Gt._�� S 7�n!�
Foundation �APA� 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
��-�-r-. ` � �Z l l L-� vA��'S
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
FEES: Valuati n Z � Permit Fee Paid $ � v Park Dedication $ � A
ISSUED BY�����''^'�" ' Date ` �r�� / Final/O.P.
In the performance is w k I agree to perform � w pursuant to rules governing the described construction.
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SIGNATURE �� ✓��
� � AGENT/OWNER DATE
ADDRESS / �� �/T ���S� 1�/ � �� �O��
TELEPHONE S
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gECOAD OF SE6+1E8 AND WAZ'Ex DISCONNECTIONS
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Date �� — � — �t
Address of Building 2.Z " �
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Name of Owner �O�tm d- � ,f����� e i�.o ��v� •
Addre s s o f Owne r �S'c��P,)
Sewer Sealed at Property Line 19 by
Water Disconnected at Property Line 19 by
No sewer and water services to premises. �
I, the undersigned, owner or agent of the above described property,
agree that all sewer and water services wi be di conMected and
sealed by a master plumber on or b f ��u
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Owner �gent �
,
Approved for issuance of wrecking or moving perm t.
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_.�o._: � - �z /
�t� '1 bing Inspector