HomeMy WebLinkAbout0020718-Electric (service change)_CITY OF OSHKOSH N° 20718
PERMIT APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
--------------------------------------------------------------------
ADDRESS
_ _ _ v _ _ PLAN NO
OWNER ~~ ~~'' , Q,
DESIGNER
USE/NATURE OF WORK ~~/~_-~~~~-~ ~ `- ~ ~~ ~ ` ~ ~ ~
-- -
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
ELECTRIC CONTRACTOR ~~
Electric Serv. New ^ Change Temp ^ Type~.~ Volts~~ Amps.~~
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
O ~ --
FEES: Valuation $ ~ B /~ Permit Fee Paid $ /~~ ~~^ Park Dedicationrt $
ISSUED BY Date !- ~'~°~ 0 Final/O.P. ~(/ "'"Q ~~~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATU ~~ _ /a -- ~' ~~Q
AGENT/OWNER DATE
ADDRESS
TELEPHONE #