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CITY OF OSHKOSH
N2 33605
- ® PERMIT - APPLICATION AND RECORD
TYPE: BLDG HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 2-4 /4C_ PLAN NO.
OWNER i<gor 0,elli
DESIGNER
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USE /NATURE OF WORK /
BUILDING CONTRACTOR #1,1
Size //6 f Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New p Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
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: Valuation -2—/ Z • �0 J Permit Fee Paid $ /0.-0.0 Park Dedication $
4 11
ISSUED BY Date 51/41C 3 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE `- Yl /24.1
I AGENT /OWNER DATE
ADDRESS
TELEPHONE #
Revised: 8/84
ZONING /LAND USE COMPLIANCE CHEC: <LIST
JOB LOCATION: - 2.. 4- TO MI GJ0- ZONING:
PROPERTY OWNER /CONTRACTOR:
CONSTRUCTION DATA: NEW CONSTRUCTION ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. mss, pool, sign, deck, etc.)
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
_ Lot Width
_ Lot Area
_ Floodplain
_ Front Yard
_ Side Street (frrnt yard)
_ Rear Yard
• Side Yard (R)
_ Side Yard (L)
_ Parking Spaces
_ Building Area •
_ Lot Area Per Family
_ Corner Lot
_ Landscaping
_ Transitional Yard
_ Off- Street Loading
_ Vision Clearance
Height
REVIEW AUTHORITY:
The Director of Community Development, or designee, must approve all plans, except the
following: (1) Alterations or interior work when the use is conforming and when no change
in use is proposed. (2) Maintenance items,- e.g. siding, windows, etc., when the use is
conforming and when no change is proposed.
Instances where work complies with the above criteria, the permit can be reviewed by the
Building Inspector without referral to the Director of Community Development, or designee.
APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY : 4,(,64rC�-a-- DATE: �� `�
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