HomeMy WebLinkAbout0005003-Electric CITY OF OSHKOSH N2 05003
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC j PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 LC _ 5 J1 6 �% f PLAN NO.
OWNER eo rr 6
DESIGNER f}�� � j USE /NATURE OF WORK LJf i/fi . i /eh/I 4 (vi S 0 O,J'Q4
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 ,4 ■/ rL fe /f ie ��n f/' f C. P
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches / Receptacles 2'""' Circuits O
L
O
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
FEES: Valuatio $ 0 c., � � /
Permit Fee Paid $ Park Dedication $
ISSUED BY 4 ? _.r %/ Date 7 �° — # g ./ � Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
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SIGNATURE G /
AGENT/OWNER
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117
ADDRESS
TELEPHONE #
PERMIT NO.&) 0 62 —_ APPL. DATE 7---(7 77
Y'// ,' ' '
ELEC. CONTR. ��
OWNER = X
ADDRESS 3 (6 —
NATURE OF WORK / ' i �4
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ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S ' o L RECEPT'S J'`CI,RC' 6N5'
APPLIANCES
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SIGNS C/ /
INSP. EST. COST - } 5 D o✓ PERMIT FEE ?c N PD��q
REMARKS
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