HomeMy WebLinkAbout0016722-Electric (a/c) 41.--) _CITY OF OSHKOSH N2 16722
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / v� / 3 PLAN NO.
OWNER - 7�
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 7 C° /P -ec,
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches K Receptacles Circuits r>‹, 94)—
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation a Permit Fee Paid $ L /.-- Park Dedication $
ISSUED BY Date /? —14' — T, Final /O.P. /- l - F
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE -s. X q /° e AGENT / ( ATr E
ADDRESS
TELEPHONE #
PE T NO. l0 . PP . DATE
ELEC. CONTR. L., 7 --el
OWNER
ADDRESS /?--/
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S.,2<c
APPLIAN S
SIGNS
INSP. ROUGHIN SERVICE FINAL[' '/ f 9
EST. COST / 2O � PERMIT FEE /1' °-=" DATE PD./69-
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