HomeMy WebLinkAbout2012-Building r •
P O Box 1130
� City of Oshkosh Oshkosh,WI 54903-1130
� Phone:(920)236-5050
Fax:(920)236-5084
Building Permit Applicatio `"`"'"•".°S"'`°S".W'.°S
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Project / � / / /� �.� MAY 1 � ?Q12
Address p���U �� (/�-�G�c.S�f1.��',�t �i�c-°P � (.�o�����
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Applicant Owner ontractor' Tenant Other(describe) C'�.MMIJ^�'?'Y C�E1;'��s'1;'MENT
Owner/ } �� � ����U
Nam�e,� � �i-e Phone
Tenant
Address���� �- �G��(.�v� J�� Email
Contractor Company Name C J'7 lGs G /� Phone �d��L�- �3�
Contact �A/'/�- G.S�l�dC Email//�CS��7'����1�`G��'s- �' ,fr�( �
Address����1 ��5�"/i'le ��->'� C�� �cclis�c�' L�l �S�/.3�
State Credential#'s , , �0 7�av�y
welling Contractor Qualifier# Dwelling Contractor# Building Contractor Registration#
Achitect/ Company Name /� Gl � Phone �8 -� j�f
Designer
Contact CLt t'{P�� i�c�"P Email
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Address � � S Jt� � f� �/4 /! r .�/T l
Permit Type Residential Single Family Residential Duplex mmercia Multifamily Industrial
Catagory e' Addition Alteration
Project �;,,e Cr�� ,�' � � ,v2
Description
Mechanical Separate permits will be obtained for the following:
Permits Electrical by I�- Plumbing by N�� Heating by /J �
Value of Job $ / 75/S"� 3 . 06 (Value for materials&labor is req.to ensure consistency in accessing perm' fees for all applicants.)
Payment by: Check # � �y�� Cash Permit Fee Account �� l(�j
/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: /�AR �f�Sh`�i N (Please print) Date: TJ' ' �S' �p�
Signature: �,C�/��