HomeMy WebLinkAbout0014099-Electric (temporary)
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CITY OF OSH.KOSH N~
PERMIT - APPLICATION AND RECORD
14099
TYPE:
BLDG 0 HTG 0 ELEC g PLBG 0 SIGN 0 ZONING
FLOOD PLAIN
HEIGHT
...-.................. --..... --...... --...... -- --...... --... --- ---... --...... -- --...... --... --.....-...... -- ..-- --.. --.....
ADDRESS
;;to 'i D fk cJfJy /j
\ }Wh wol(-.
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PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK ~flSY ~ S'VY J /'<.- L .
BUILDING CONTRACTOR
Size
Sq. Ft.
# Rooms
# Stories
Height
, Occupancy Permit
Foundation
Class of Cons,.
HEATING CONTRACTOR
Heat 0 AlC 0 Vent 0 Fuel/System
Heat Loss
BTU'S
ELECTRIC CONTRACTOR
~
~a__~
Electric Servo
New 0 Change 0 Temp ~ Type _ Volts _ Amps_
Fixtures
Switches
Receptacles
Circuits
~
PLUMBING CONTRACTOR
_BT _WH _Disp _ WSoft _ CBasin
_Lav _Sh _OW _OF _ San. Sewer
_WC _FOr _SP _Ur _ Storm Sewer
_Sink _ L Tub _ Eject _SS _ Water
Other
ISSUED BY.
Permit Fee Paid $
Date
I
tD J
? -;z & ~-IT,}
'"
Park Dedication $
Final/O.P. & -;;2..h- If 9'
L
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
.~~
AGENT/OWNER
Gh6 P?
t DATE/
ADDRESS
TELEPHONE #
ADDRESS
NATURE OF WORK
6 --.z-yj'
.'
PERMIT NO.
E c. CONTR.
OWNER
./
;;{
CJ
CHANGE
VOLTS { 2-0
,RECEPT I S
TEMP .
AMPS
eIRC'S
S I'GNS
IN P. ROUGH N
'. EST. COST
REMARKS.
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