HomeMy WebLinkAbout0143647-Building City of Oshkosh
Inspection Services Division
PO Box 1
Oshkosh, WI 54903 -1130
Phone: (920) 236 -5050
Fax: (920) 236 -5084 OJHKO./H
Building Permit Application ON THE WATER
If you are a contractor participating in the Permit Fee Account System and have adequate funds, check here
if you want this processed through your account Fl
JOB ADDRESS Z. 03 0 4re-A Q .' v e
ID
OWNER N 'bow Lt , vim
CONTRACTOR D0 ��,ST kVGT/ Co -�-c a20- 420,0772_
I am the: ❑ Owner OR ❑ Contractor E ,, . .)\
USE CATEGORY / '``
❑Single Family ❑Duplex ❑Multi- Family ❑Rental Commercial ❑Industrial
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Work being done:
❑ Addition ❑ Deck/Porch/Patio ❑ Driveway /Parking `A
❑ External Remodeling ❑ Fence /Hedge /Kennel ❑ Garage/Utility Structure
❑ Handicap Ramp ❑ Hot Tub /Spa Internal Remodeling
❑ Sign/Canopy /Awning ❑ Stair /Handrail ❑ Stove /Fireplace
❑ Swimming Pool ❑ Wrecking Permit
❑ Other
Additional information, such as plan submittal and approval, may be required before issuance. Fliers,
located in the hallway, may be referenced to note if any additional information is necessary.
❖ Full description of work being done: ADD PO 7 r o.Q n f F! z Es
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bhw 29 2010
1 + ..
,OMMUNI'ry DEVFELOPMEN3
' SPFI ION SERVICES DIVISION
Any work not included in this application is not permitted.
Value of the job $ ,j 0 0 a
l (Value for materials and labor is required to ensure consistency in accessing permit fees for all
applicants.)
PLEASE READ, SIGN, & DATE:
1 certify the above information is complete and accurate. Any deviations from the above submitted
information may require additional permits to be obtained. I acknowledge and agree to these terms.
Name: o cuMID — o
(Pl- •rint)
Signature: Z•
Date: