HomeMy WebLinkAbout0012108-Building (raze) n _ CITY OF OSHKOSH No 12108
PERMIT APPLICATION AND RECORD
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TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING �'� FLOOD PLAIN � HEIGHT/" �'�'
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ADDRESS � S�� n�L—�'�v/��a I��--V(J • PIAN NO.
OWNER�'.ZrIZ//a C.L� /�/\A({�l,) S��
DESIGNER
USE/NATURE OF WORK ` �-� � S �Z�� �U��/��
BUILDING CON�'RACTOR �° �� �+s�
Size Sq. Ft.l vUU � v# Rooms # Stories � Height
Foundation ��v� �-`-f��-� Class of Const. `� v 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 '`��'`J ��'Q `�
—BT WH —Disp —WSoft —CBasin
—Lav —Sh —DW —DF San. Sewer
_WC —FDr —SP —Ur —Storm Sewer
—Sink —LTub Eject SS —Water
Other
FEES: Valuati n � Permit Fee Paid $ �� Park Dedication $ I�
ISSUED BY � Date! �1 Z — 0 7 Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE � � o �
�AGENT/OWNER DATE
-�J \ � � � �
ADDRESS (� f �,� '
TELEPHONE#
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P •
BECOED OF SE6�EE AND WATEFi DISCONNECTIONS
Date � � �� �'/
Address of Building
�
Name of Owner �
Address of Owner
Sewer Sealed at Property Line 19 by
Water Disconnected at Property Line 19 b�
No sewer and water services to premises. �
I, the undersigned, owner or agent of the above described property,
agree that all sewer and water services wi be disconnected and
seal�d by a m�ster plumber on or before P / �'
Oy',�"r'- ��v'� i,� �
�'� ��n,�� - � �f� ` �.��
Ot,� �/v���G'�`��'`�� zcC����� ' 0 er ent >
�"" �,�,�,, C 41'��� �
Approved for issuance of wrecking or moving p�rmit.
( - ! � U l i�., C-c!'.''�C�--'C/"�-G/ .,�,�/- _�..
� P1 mbin� Inspector
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