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CITY OF OSHKOSH N 39801
PERMIT - APPLICATION AND RECORD
(r)
TYPE: BLD HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS •9 / ' ' ///1 ST
_, PLAN NO.
OWNER Sr &�( Atib KNI ,E4/1X
DESIGNER
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USE /NATURE OF WORK (S FR) CON oc7 6 wq pN
4cr (// zb.
BUILDING CONTRACTOR C7l0ti67 2
Size 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 $ Ste' ' Permit Fee Paid /0 ' "
$ Park Dedication $ '^—
ISSUED BY Date 6/3/94/ Final /O.P. r-----
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ; (2 f4 , AGENT /OWNER _ � / ii.,,,„ DA
ADDRESS C7?1 /' *vim) I�� ,3/.- ( /, 56.
TELEPHONE #
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: '7 S l� ,/ /ti c (J/ ZONING:
PROPERTY OWNER /CONTRACTOR: % EIJ 4 b /iv( ! Nk
CONSTRUCTION DATA: 4NEW CONSTRUCTTI{1 ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e4:fe pool, sign, deck, etc.)
31 /1/6N U.iC b /av '&4 /rez
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT OEFICIENCY /COMMENTS
Use
• Lot Width
_ Lot Area
Floodplain
_ Front Yard
Side Street (frirt 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 41L_APPROVED wi thout referral to the Director of Community Development, or designee.
DENIED
Plan Commission Action Required
Variance(s) Requir
REVIEWED BY: DATE: 6, ,F F
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