HomeMy WebLinkAbout0012160-Electric CITY OF OSHKOSH N2 12160
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /c Al d S 1- PLAN NO.
OWNER \-b Li) dik
DESIGNER
USE /NATURE OF WORK ? Jr
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 r f'� � GIy i L
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles, Circuits
*pc
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
0 /
FEES: Valuation $ O. 00 Permit Fee Paid $ (0 0 Park Dedication
ISSUED BY / z_
Date / "2 — 7 7 Final /O.P.
In the performance of this w k I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ` r- -- `Z G / — c 2 0 -- ff
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. 2■./o D • . 2P _ . D.T /- 7 - 2
ELEC. CONTR.
OWNER d e -
ADDRESS / -' - —
NATURE OF *R
• wow-
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMP
X S /k' S 4/ RECEPT' S C RC' S i-
APPLIANCES
GN
NSP. RO GH N • ( - . ,,4 RV F N
EST. COST O v PERMIT FEE in "L-----DATE PD./ 20-, 7
REMARKS