HomeMy WebLinkAbout0009024-Buidling (raze) � � � CITY OF OSHKOSH No 09024
`' PERMIT — APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS � Z �� PLAN NO.
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OWNER V ° � f� ( V�� � c/V r S' ° ' J
DESIGNER
USE/NATURE OF WORK ��
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BUILDING CONl"RACTOR �
Siz� X� Sq. Ft. # Rooms # Stories � Height
Foundation Class of Const. Occupancy Permit '
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
—BT _WH —Disp —WSoft —CBasin
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_Lav —Sh —DW M,��Q�F�?�a —San. Sewer
—WC —FDr _SP Q B RQ�a�r��16�1�e� —Storm Sewer
—Sink —LTub —Eject mmo�C���6�3C —Water
Other V�
FEES: Valuation Per t Fee i •'�- Park Dedication $
ISSUED BY Date CP ��d `g� Final/O.P.
In the performance of this work I agree to perfo all work pursuant to rules governing the described construction.
SIGNATURE �� �
AGENT/OWNER TE
ADDRESS
TELEPHONE#
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gEC08D OF SER,rdEII AND WATEA DISCONNECTIONS
Date � �
Address of Building
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Name of Owner V w "
Addre s s o f Owne r ,
o e rt Line � �3 � 1� b9 ����� � �
Sewer Sealed at Pr p Y �
Water Disconne
cted at Property Line�.-��; � 19�=b� ������ �' � �
No sewer and water services to premises. r-1
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I the undersigned, owner or agent of theiil°be disconnected andt9�
agree that all sewerlumberaonrorebefore W
sealed by a ma.ster p
Owner Agent
Approve for issuance of wrecking or �ing permit.
e
� r` P1 mbing Inspector