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HomeMy WebLinkAboutElectric ��I CITY OF OSHKOSH N� `'�� � � n PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS � �Z � �� � / �Z / � �� (�1 • PLAN NO. OWNER �L d�'1 ,/Yo7�l�� DESIGNER USE/NATURE OF WORK BUILDING CON7RACTOR Size Sq. Ft. # Rooms # Stories Height • Foundation Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ❑ A/C ❑ Vent ❑ Fuel/System Heat Loss BTU'S � � � j � ELECTRIC CONTRACTOR Electric Serv. New�Change ❑ Temp ❑ Type�� Volts3� AmpsZ��� ��¢C f'`� 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 �s�'e' � " " Permit Fee Paid $ ��` �� Park Dedication $ ISSUED BY � �'����� Date�'� � � FinaU0.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE AGENT�OWNER �ATE ADDRESS TELEPHONE M