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HomeMy WebLinkAbout0152104 - Building (restroom remodel) P O Box 1130 02 City of Oshkosh Oshkosh,WI 54903-1130 PhFax: (920)236-5084 Fax: (920)236-5084 Building Permit Application www.ci.oshkosh.wi.us Project ? Address _ •�7 2 Gdos . _ r� — 5T .A !7 h Applicant Owner C ontractor Tenant Other(describe) n 1 i 7 n 1 Owner/ Name ©SA(<v*ink CO2 e• Phone DEPARTMFNT OF Tenant COMMUNITY DEVELOPMENT Address Email INSPECTION SERVICES DIVISION Contractor Company Name R. 'J 1 /4L�32 LC. - % Phone 2 31 - 8635 Contact SCDZf J CKt/t/t#M .R13 Email SCalrt.Krik.f3etC-J?7. Coo Address 5'7 il C'112futi) \Act.A.Y 2FJ. 0S/( 9{ k)( SYSby State Credential#'s , , 3/ Dwelling Contractor Qualifier# Dwelling Contractor# Building�C;ontractor Registration 4 Achitect/ Company Name 77 g• h/ 4 /2ft cS 4. /15$c. Phone V26, - WV Designer ,/ Contact J C.4(/3 K f F_CK - Email _VgAJ L'xaceietC5. C0 Address (q'3 Y 4c-abv(4 S'—v6 0541co SK rte/ Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial Catagory New Addition Alteration Project ' 71.0P9w( Wlv/1'(0�<6. /*or Pc-4005/ Description `t)`( �. S /\ co/7M-- Mechanical Separate permits will be obtained for the following: r , Permits Electrical by g1% Z�C �.Lt 72 lumbing by JrM S I,rG vj/,t?A Heating by Value of Job $ 71 509• J (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.) Payment by: Check # Cash Permit Fee Account I certify the above information is complete and accurate. Any deviations from the above submitted information may equire additional permits to be obtained. I acknowledge and agree to these terms. Name: 5, [ , (Please print) Date: Signature: I AM',_ - -