HomeMy WebLinkAbout0039726-Electric (service change)~,3 f
~ N°_ _39726
` CITY OF OSHKOSH
PERMIT -APPLICATION AND RECORD
TYPE: BLDG ^ HTG ^ ELEC~ PLBG ^ SIGN ^ ZONING FLOOD PLAIN HEIGHT
ADDRESS ~" ~ G
OWNER
DESIGNER
USE/NATURE OF WORK
PLAN NO
BUILDING CONTRACTOR
Size
Foundation
Sq. Ft. # Rooms # Stories Height
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 1~ Volts~~ Amps~d
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
- BT - WH - DisP - WSoft
-Lav ~ -Sh -DW -DF
- WC - FDr - SP - Ur
- Sink - LTub -Eject - SS
Other
FEES: Valuation --Q' ~.~' O J Permit Fee Paid $ ~ Sr • ° v
_ Park Dedicati n $
ISSUED BY Date ~~~ 5~ Final/O.P. "" ` ~~
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
t~
SIGNATURE
ADDRESS
AGENT/OWNER
-. CBasin
-'San. Sewer_
-Storm Sewer
-Water.
DATE
TELEPHONE ~
PERMIT NO . J / ~~ APPL . DATE ~ L 5 ~ ~1
FIX'S SW'S ~ RECEPT'S CIRC'S
APP TANCES
2
ELEC CONTR ~i~~~s-/1
REMARKS