HomeMy WebLinkAboutTemporary Occupancy Permit - 02/08/2012 �
� cuyoeo5t�osn
� Division of Inspecdon Services
215 Church Avenue
PO Box 1130
OIHKQlH Oshkosh WI 54902-1130
Office 920-236-5050
ON TME WATEF Fex 920-236-5084
Temporary Occupancy Permit Application
Address for the Requested Temporary Occupancy Permit: :3�7C'� J/1��Sp� ��
Occupancy or Use of Structure: - � . �
Building Permit Number: �'7'8�1g Issue Date: � �
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Applicant Information
Name: �j�e� �G�ll�(,vULl1-�
Company Name:�� J ��� ���
Mailing Address: S''"J/j �RK��1/ ��Y /��J .
Phone Number: r-1'1(J-2�✓J-�v35 Fax Number: ��-�3/- ,375°I
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As (check all that apply) the owner, the General Contractor, the Buildmg Permit
Applicant, the agent for the owner, I hereby request approval for a Te p ary Occupancy Permit
at t orementioned address. Temporary Occupancy is requested from��date)through
7 / (date.) I agree to abide by any Conditions of Approval. I understand that Final
ccupancy Approval or a Temporary Occupancy Permit Extension must be secured by the Temporary
Occupancy Permit expiration date or I may be subject to Municipal Citation issuance for each day the
structure is o upied without the required Occupancy Permit.
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(Applicant Signature) (date)
----------------------°--------°---------------------------------------------------°------------------------------------° .
(Office Use Only)
Application Status: �/ Approved Denied Expiration Date:3� Z Fee Collected Ia�•`�
Comments/Conditions of Approval: _ ��,,,1�,,,.,L-�,,; �,c�st�;,�r�,; y�t C��J�r� �Ta 3�
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Reviewing Inspector: Date: Z,,
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