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HomeMy WebLinkAbout0047152-Building (tear out chimney) p ~ CITY OF OSHKOSH PERMIT - APPLICATION AND RECORD /L{(j N! - 47152 ~P_E~ _ _ ~L~~ ~ ~T~ _ ~ _ ~~E? _ ~ _ ~~B~ _ ~ _ ~I~~ _~ _ ~O_N~N~_ _ _ ; _ _ _F~~~D_ ~~I~ _ _ _ _ _ _ ~~I~~T_ _ _ _ _ ADDRESS -5;;)..1 \'Y1" ~~.)D"" -S +- ~ ~k PLAN NO. OWNER ~. SOc-,V'Y\..e-.I '9~\\:l\5,t)-. DESIGNE~ USE/NATURE OF WORKS~ ~ I -1.er.f" C~ (')\~ < \. , \ _ ~ '0 (\. ~ ~ VV"' -. <; I')"" (':J <.l.--", N'" y'I {L':J C~\\IV\\'\-e ~ :) (ZP't.. 6c ('" y,.p 0 BUILDING CONTRACTOR U.. ~'(lo ~~ VV\L. '\i11/)l\j Size Sq. Ft. # Rooms # Stories Class of Const., e, ':2, Height Occupancy Permit 'f ~\J~ f~~ Foundation HEATING CONTRACTOR Heat D AlC 0 Vent 0 Fuel/System Heat Loss BTU'S ELECTRIC CONTRACTOR Electric Servo New 0 Change 0 Temp 0 Type _ Volts Amps_ Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR _BT _WH _Sh _Disp _OW _SP _ WSoft _OF _ CBasin _WC _FOr _ L Tub _Ur _ San. Sewer _ Storm Sewer _ Water _Lav _Sink Other _ Eject _SS Permit Fee Paid $ CAO 0"0 Date <J - I Ll ~ <.; r;- / I V FEES: Valuation $ ~.c;l) 0 ob ISSUED BY 'D--0 Park Dedication $ Final/O.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE ~d"~ ~~ , AGE~T/OWNER 5J./ m4JJLS~ 5f } ,. / L;"75 DATE D ~ --c) 3 gs-- TELEPHONE # ADDRESS