HomeMy WebLinkAbout0042809-Electricb ~i
IT HK H N°- - 42809
C Y OF OS OS
PERMIT -~ APPLICATION AND RECORD
TYPE: BLDG ^ _HTG~- ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
3
ADDRESS ~
~
~~~~
PLAN NO.
~.,
OWNER
DESIGN
USE/NATURE OF WORK
BUILDING CONTRACTOR
Size
Foundation
# Rooms
Class of Const,
# Stories Height .
Occupancy Permit
HEATING CONTRACTOR
Heat ^ A/C ^ Vent ^ Fuel/System Heat Loss BTU'S
ELECTRIC CONTRACTOR / ~~'
Electric Serv. New~Change ^ Temp ^ Type
Fixtures Switches Receptacles
Volts3~ Amps
Circuits
PLUMBING CONTRACTOR
BT _ WH _ Disp - WSoft - CBasin
_Lav _Sh -DW -DF
WC _ FDr _ SP _ Ur
_ Sink _ LTub _ Eject _ SS
Other
FEES: Valuation $ ~ o o• 'Z- Permit Fee Paid $ , 0, o J Park Dedication $
ISSUED BY Date 11,/~~T FinaUO.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER pq~
Sq. Ft
-San. Sewer_
-Storm Sewer
Water
ADDRESS
TELEPHONE #
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