HomeMy WebLinkAbout0149410-Building (add revised rear exit) /� G P O Box 1130
City of O shkosl L Oshkosh,WI 54903-1130
Phone:(920)236-5050
Fax: (920)236-5084
Building Permit Application www.ci.oshkosh.wi.us
Project
Address cZ 0 0 C ,404-Pr
Applicant Owner Contractor Tenant Other(describe)
Owner/ Name L3-z! i i ri. 12e ‘4._.,/a la /X.ie Phone V.Z-67 —/ p7.3
Tenant
Address y0 Ltd (/1 -h( ✓� Email r-tic �!icr�
Contractor Company Name Phone 471e1,,, IQ 7_3
Contact La.rSan Email K oto, df2
Address () 6j. ( di /rive,
State Credential#'s
Dwelling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name /}{e,A,,.4 J, Cp(yi en Phone o)..3
Designer
Contact M �t �- Email
Address_t, 7 a�CO �' '-' 1'J t
Permit Type Residential Single Family Residential Duplex rCommercialT Multifamily Industrial
Catagory New Addition Alteration
Project 9#2 Z L �.�
Description f� -ft
ItJ
kiwi perm_
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job
$ 3-Q Q (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # ( 7 Cash Permit Fee Account
I 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: 5(AQ gust KQ (Please print) Date: 3/? hv.,
Signature: /C //t