HomeMy WebLinkAbout159734-Building (door replacement), '� ��
C.�"� ./
P O Box 1130
� �Lt�/ � �s���s� Oshkosh,WI54903-1130
l � Phone: (920)236-5050
� Fax: (920)236-5084
Building Permit Application �'�'•ci.oshkosh.w�.us
Project � . /� �
Address
Applicant � - Contractor Tenant Other(describe) - -
Owner/ Name �
Tenant � '�� � �1 -� ��� Phone o2,3J - a�pl�U
Address_ ,1.�'r} ,�,1.e. r,..s G,,, �r U� Email
Contractor Com an Name� �
P Y -�'yLLJ i ��cz � ct Phone
Contact Email
Address
State Credential#'s ,
Dwelling Conh•actor Qualifier# Dwelling Contractor# Building Conh•actor Registration#
`�� Company Name Phone
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Contact Email
Address
Permit Type Residential Single Family Residential Duplex Commercial Multifamily Industrial
Catagory New Addition �_Alteration
Project ��� �--e , � �c v�
Description
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job ���,�'�
$ (Value for materials&labor is req.to ensure consistency in accessing permit fees for all applicants.)
Payment by: Check # Cash Permit Fee Account
I ce�•tify the above information is complete and accurate. Any deviations from the above subn:itted info�•mation may require additional pernsits
to b btained. I ac�n wledge/and agree to these terms.
Name: ��� �l f���4 <1 G� �� (Please print) Date: c� 'r�s— ��
Signature: � � ��2��/��fl�� :