HomeMy WebLinkAbout0026848-Electric (service change) CITY OF OSHKOSH N°_ 26848
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3 6 5124 h'e I H ". PLAN NO.
OWNER l I ( Prn Tc 1/
DESIGNER /
USE /NATURE OF WORK SPfU(c 2 " 66 - 7'6 3 /00
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 HO r N 11 `e
Electric Serv. New ❑ Change ❑ Temp ❑ Type 3 Volts / "/ ii{G4mps /c'®
Fixtures L- Switches L_.. -- Receptacles 1 Circuity ----
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: Valuation $ /dc9 o— Permit Fee Paid $ cJ o —� v.' Park Dedication $
ISSUED BY G YfaIe./1 Date /2-7/ Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUR 41-4 -... /-5 j —F(
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
APPL. DATE
PERMIT NO. /
_ C. ONTR. A
OWNER /
z•DRE S
NA TUR F WOR
C HANGE .� TEMP
• RV . NEW � � ..f O AMP i !,
• -E :!Y� RECEPT' t. CIRC' S
FIX• SW' S
z S •
GN _ �� "/ , FINAL
N.P. ROUGH _N' ` /'- SERVICE F- DATE PD - l-9
E . COST l i' %`-� PERMIT FEE d
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