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CITY OF OSHKOSH N° 20191
` PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING ��y FLOOD PLAIN HEIGHT
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ADDRESS � 3 � � PLAN NO.
OWNER � /L�'� O�L�'�'
D NER
�.'�`�CC' , � i � � �
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USE/NATURE OF WORK `� � F"'� �
`' � — -z -�o ��i�� p-Z?�P�
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BUILDING CONTRACTOR ��e'�-P �`-
Size / �` � Sq. Ft. # Rooms # Stories Height �
Foundation��'-��1F' 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
—Lav —Sh —DW —DF —San. Sewer
—WC —FDr —SP —Ur Storm Sewer
—Sink —LTub —Eject —SS —Water
Other
/
FEES: Valuatio $Z7f ° Per it F Paid $ ��� Park Dedication $ �`�'
ISSUED BY Date Z� � Final/O.P.
In the performance of t is work I agree to rform all work pursuant to rules governing the described construction.
SIGNATURE
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AGENT/OWNER OATE
ADDRESS
TELEPHONE# �
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Revised: 8/89 =
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ZONING/LAND USE COMPLIANCE CNECKLIST �
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JOB LOCATION: �3 3 7 �-C'��.�-�'i-� ZONING: C �
PROPERTY OWNER/CONTRACTOR: d�il-� �� '
CONSTRUCTION DATA: NE1J CONSTRUCTICN AODITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUC7ION: (i .e. fence, pool sign deck, etc.)
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COMPLIANCE CHECKLIST (Checfc only those applicable)
COMPLIES DEFICIENT DEFICIENCY/COMMENTS '
Use
Lot Width
lot Area
Floodplain '
Front Yard
Side Street (fra�t yani)
Rear Yard
Side Yard (R)
Side Yard (L)
Parking Spaces
- Building Area
Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off-Street Loading
Vision Clearance
Height �
REVIEIJ AUTHORITY:
The Director of Community Development, or designee, must approve all plans, except the
� following: (1 ) Alterations or interior work when the use is conforming and when no change
in use is proposed. (2) Maintenance items,� e.g. siding, windows, etc. , when the use is
conforming and when no change is proposed.
Instances where work complies with the above criteria, the permit can be reviewed by the . :
Building Inspector without referral to the Director of Community Development, or designee. ;
�'APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEIJED BY: -� DATE: ����f°
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