HomeMy WebLinkAbout0010870- Raze `' CITY OF OSHKOSH N2 10870
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 00 ( IC). i`-a u- ic PLAN NO.
OWNER rc•� X. Oft /4 y -�q U c` to .�
DESIGNER
•
USE/NATUR F WORK &-cr--'t` d c -cP r-r to ti o 0 T - ' ` r
vsc._
BUILDING CONTRACTOR / OC9----s- F �r Q l�`
Size Sq. Ft. # Rooms # Stories ( /Y. Height
Foundation /2 V`s 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 $ P: it/Yid $__ .,__Gjz,/__
/O� Park Dedication $
' -�� Final/ .P.
ISSUED BY ��� r Date � O
In the performance of this work I agree to p•rf., all work pursuant to rules governing the described construction.
SIGNATURE // ) / �=(•�11. /OA J
7 AGENT/OWNER DATE
ADDRESS Ce39 eiii L712 • 05APLA/ WI 5/90z///Uy `T D-5OCJO
TELEPHONE#
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RECORD OF SEWER AND WATER DISCONNECTIONS
Date g( 4
Address of Building /74P/ A
Name of Owner
Address of Owner �
Sewer Sealed at Property Line 47/6-9 19y �7( jP
Water Disconnected at Property Line ?/i419 y C `c.
No sewer and water services to premises. Ej
I, the undersigned, owner or agent of the above described property,
agree that all sewer and water services will be disconnected and
sealed by a master plumber on or before
(Owner) (Agent )
Approved for issuance of wrecking or movIng,pe?i/c24"--
mit.
r
Date Pluming Inspector