HomeMy WebLinkAbout0040500-Building (water damage in basement)J -y0
CITY OF OSHKOSH N° 40500
PERMIT - APPLICATION AND RECORD
TYPE: BLDC�HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS r� � 4t "J '�C` (' PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK �>-
r
t rril -1 1
BUILDING CONTRACTOR lc�wt,L,e (-
Size 6-��Sq• Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type
Fixtures Switches Receptacles
PLUMBING CONTRACTOR
_BT —WH
Lav _ Sh
— WC — FDr
— Sink — LTub
Other
Heat Loss BTU'S
Volts Amps
Circuits
Disp
— WSoft
— CBasin
DW
— DF
_ San. Sewer_
— SP
— Ur
—Storm Sewer
Eject
_SS
— Water
FEES: Valuation $ Pe7YFee Paid $ ��� f 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.
/ 4' 9 y
SIGNATURE AGENT /OWNER DATE
ADDRESS TELEPHONE #