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HomeMy WebLinkAbout0030150-Electric (repair service) � CITY OF OSHKOSH I�° 30150 `' PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ' ADDRESS �G 1 �' ' � PLAN NO. `' l � OWNER —G�� e DESIGNER i USE/NATURE OF WORK -P I/�t t v- -S E'�I,'1 � -� BUILDING CONTRACTOR Size Sq. Ft. # Rooms # Stories Height Foundation Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S 4�' - : ELECTRIC CONTRACTOR J � �= �`"� . Electric Serv. New ❑ Change ❑ Temp ❑ Type� Voltsl � Amps �5 � 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: Valuation $ ��— Permit Fee Paid $ �'S—� Park Dedication $ ISSUED BY Date ����- ��—�-� Final/O.P. �" � Z �� In the performance of this work I agree to perform all work pursuant to rules governing the described construction. � f - SIGNATURE �`�� 'LC�t. � �2 AGENT/OWNER DATE � ADDRESS TELEPHONE# � ) } � ��v PERMIT NO. � . APPL. D TE > - � � (l - � .� %-- ELEC. CONTR. �x - -�'t f� . � -% / OWNER t� f( _ .� �.c � �-C. ADDRESS ,� �� - ��� ��c ����� - NA'iURE OF WORK � ��1.�--�� << < �� � � .������ c c"��� C ` / � � ELEC. SERV. NEW � CHANGE . TEMP.«f�•�7; DESC. TYPE VOLTS ANiPS � FIX' S SW' S RECEPT' S CIRC' S APPLIANCES � . o' . SIGNS ' INSP. ROUGHIN SERVICE ' ��� r : INAL - EST COST /S�d ' PERMIT FEE�<1/ DATE PD.�5'-�a y�i' REMARKS