HomeMy WebLinkAboutElectric (temp. pole service) 46) _CITY OF OSHKOSH N2 14029
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ' f PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS // 1--Gt' a /6J 0 0 A J ,a
PLAN NO.
OWNER L- A- 4 a , ,/t/P- 0914/41.4■6
DESIGNER
USE /NATURE OF WORK ',/ 90 .>LA
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 Pae.. i at..�
Electric Serv. New ❑ Change ❑ Temp K Type a 6 Volts /t- Amps 60
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
5- r / v /� /
FEES: Valuation $ ! O -------- - Permit Fee Paid $ ! a�� Park Dedication $
ISSUED BY di•4-r... _- - - Date to " -P, F /O.P.
In the performance • ork I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE I ��JI ,/ ‘ „/J
AGENT /OWNE 7
DAT
ADDRESS
TELEPHONE #
PERMIT NO. / Ve ./ . APP DATE C - _ r 7
ELEC. CONTR. L-
OWNER g'12e
ADDRESS l I cc RA---1' 71,1,17
NATURE OF WORK
k
ELEC. SERV. NEW CHANGE t
DESC. TYPE ) v e VOLTS 1, -"/ O AMPS 4 c'
FIX'S SW'S RECEPT'S b.e CIRC'S'>&
APPLIANCES V
SIGNS e ; 1 0
INSP . ROUGHIN OST a, ti -- SERVI C �," / - _ _ ', 5 t
EST. COST �(,�' / �� z'7�FINA?,/ - �
REMARKS PERMIT FEE `d DATE PD I+ JZ