HomeMy WebLinkAboutElectric 411.) CITY OF OSHKOSH N° 19488
- PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC [{BG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 6d /%i/
PLAN NO.
OWNER '"' '
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 " e " ----'--\1°.*'.
____O
Electric Serv. New ❑range ❑ Temp ❑ Type Volts Amps T— r
lj:_)
F ixtures Switches (--"`Aeceptacles _--- 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
p G °i ce "_
FEES: Valuation $ �Q Permit Fee Paid $ i i `/ / � - Park Dedication $ p
ISSUED BY / Date 7 — re Final /O.P. g a, - l o
In the performance of this I a• -e to perform all work pursuant to rules governing the described construction.
N
SIGNATURE / /7 D
7- """
/OWNER
DATE
ADDRESS /
TELEPHONE #
PERMIT NO . / 9 all 7r . APPL . DATE 1 - -I/ - 70
ELEC. CONTR. eel-" 9./' C-g
OWNER /(-Zd)--Ir'n�
ADDRESS AC 4 7
NATURE OF WORK
ELEC. SERV. NEW )..., TEMP. P
t✓ -- VOLTS ! y - t v AMPS t
DESC. TYPE CIRC'S
FIX' S P 3 SW 'S OS RECEP S 4
APPLIANCES V. 1\
GN / . t
EST . COST l .. OSTGHIN _ ��f PERMIT 7 D 7 -
INAL
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ET S� G
REMARKS