HomeMy WebLinkAbout159942-Building (draintile and sump pit) � P O Box 1130
CLt'�,l Of OS�kOS� Oshkosh,WI 5�903-1130
� .J Phone:(920)2�6-5050
Fax:(920)236-�084
Building Permit Application �+'�vw.ci.oshkosh.W�.us
Project `_-�Vl �� f
Address � 1 � j �� �� ��f�
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Applicant Owner Contractor Tenant Other(describe)
Owner/ Name ����}C.� ���i _
Tenant 5 Phone � «
Address �olt.e� `�"` U-e O�
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ob� � � a ,��1�, Email
Contractor Company Name � -�-� Phone�(��(o�^C1(p(��
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Contact ,5�� � Email � �j� � �
Address�S� � E-�f'C�1'�'' �E,X `M Q11 F, s�ti �. �--�`` ��L(�1�
State Credential#'s ��0�� p����j�y �
Dwelling Contractor Qualifier# � Dwelling Contractor# Buildin�Contractor Registration#
Achitect/ Company Name Phone
Designer
Contact Email
Address
Permit Type Residential Single Family Residentia(Duplex Commercial Multifamily industrial
Catagory New i �on lteration
Project ` �
lC'1�l��r (�( G,r,-�-t 4..t � G � C r 4,v�-�O
Description ,., �
Mechanical Separate permits will be obtained for the following:
Permits Electrical by Plumbing by Heating by
Value of Job �!�l�, °�
$ C��CT`i� ---' (Value for materials&labor is req.to ensure consistency in accessing permit fees For all appiicants.)
Payment by: Check # Cash Permit Fee Account
1 cerlifj�!he above information is contple(e and accrtrale. Any deviations from Ilie above subnril�ed information may require addiliona!permits
to be ob[oined. ! cknowledge and agree 7o these lernrs.
�- �Name: ��r., (P(ease print) Date: I I � I t�
Signature: