HomeMy WebLinkAbout0040622-Building (add dormer) /t �
N°_ 40622
� CITY OF OSHKOSH ;
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG�HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS r C��� PLAN NO.
OWNER `c� � c �c�(J � t-�
DESIGNER
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SE/NATURE OF WORK � �� � L�Yl�' X l �e
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BUILDING CONl'RACTOR d�-S '`�"��K'�
Size Sq. Ft. # Rooms # Stories � � Height :
Foundation Class of Const. Occupancy Permit��
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HEATING CONTRACTOR —"
Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S
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ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
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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
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FEES: Valuation � Per i ee Paid $ -S� � Park Dedication $
ISSUED BY Date �� Q — 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 �^��� ( �
� AGENT/OWNER DATE
ADDRESS—�/ �/ ""v �/ �� �U� 4'��`�D��
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owriER �. ' ' a�DxESS� 1'71i��� ��m - - -
DATE �-c�r � PERriIT #�� USE �,1-=�
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—�— GENERAL CONTRACTOR � -
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MASON CONTFACTOR � ZONE � ^n ��
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Width of lot DATE INSPECTIONS
REMARKS
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MAILItvG aOD�ss
Front of lot
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