HomeMy WebLinkAbout0021459-Electric (temporary) CITY OF OSHKOSH N2 21459
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC [t i LBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / /cG ��- �y��- --c-
/) PLAN NO
OWNER "/'(r /- -�`'c'
DESIGNER
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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
1 , / ),Wd ❑ Change ❑ Temp �� Type 'V Vo Electric Serv. New Amps
Fixtures Switches Receptacles Circuits ik
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
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/ PL "�!
FEES: Valuation / '� Permit Fee Paid $ < Park Dedication $
ISSUED BY • • .y el. Date / �1.2 Final /O.P. , ``/ e – ' 7 °
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
/ / //, -
GENT/OWNER
DATE
ADDRESS
TELEPHONE #
PERMIT NO. .APPL. DATE -70
ELEC. CONTR. �.�it /��� - r
OWNER /St
ADDRESS /t i•
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP. A C
DESC. TYPE 3 -cam - l/- VOLTS t �i D AMPS
FIX'S SW'S RECEPT'S Of CIRC'S
APPLIANCES
SIGNS (ceZ )
INSP. ROUGHIN SERVICEer 7 -) Ta FINAL I
EST. COST ��°_— PERMIT FEE /d ° DATE PD. //
REMARKS
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