HomeMy WebLinkAbout0010540-Electric (service change) 41y) CITY OF OSHKOSH N o 10540
— PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC II-4LBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 7ZZ W. in ix PLAN NO.
OWNER And -f li o V es L
DESIGNER v
USE /NATURE OF WORK Seri/ l C6 Chan 3 - ` o U 7 —/ e d
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 1 r k G lee-ft i C.
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches ✓ Receptacles ✓ Circuits ✓--
99 .
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
l
FEES: Valuation $ I 0 0 Permit Fee Paid $ .,l 0. CD Park Dedication $
ISSUED BY Date 7 — 2 — 7 7 .FeY
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
4.
SIGNATURE 4 Q -ZI_??
/ � n ,� AGENT /OWNER DATE
ADDRESS
6142 / " ' ` to K
TELEPHONE #