HomeMy WebLinkAbout0046985-Electric (temporary) Ho f
CITY OF OSHKOSH N° 4695
L' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC tii PLBG [j SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS / 0 S 5r / 4.-y4-
PLAN NO.
OWNER A..c/ ;:g1.1/
DESIGNER O /
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 'GµGl..cn---d
Electric Serv. New ❑ Change ❑ Temp yr Typeq 6 Volt3C Amps MI
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
FEES: Valuation $ 7S' - 0 0 Permit Fee Paid $ 10 ' c) 0 "` Park Dedication $
ISSUED BY °71— Date 0° A N
Final /O.P. ,
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
6 0
PRO' NO.
. APPL . DATE
OWNER. 4.-re 64
ADDRESS / C S 5 .G,,t
NATURE OF WORK
/c/5 Get- -
f,LEC. SERV. NEW CHANCE TEMP.
pESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
;NSP. ROUGHIN r IBS SERVICE zp FINAL
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AST. COST 3o 0 o PERMIT FEE t" DATE PD . bp-VC Y
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