HomeMy WebLinkAbout0012161-Electric 41.--) CITY OF OSHKOSH N2 12161
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC "PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 2 3 MV Sf - ' PLAN NO.
OWNER AIO
DESIGNER
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 Sr? � Cfri C_
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches ,...\----' Receptacles Circuits .....--\s- _
AD— ,
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 $ . 00. 00 Permit Fee Paid $ S-0' 00 / Park Dedication $
d4i&
ISSUED BY - 1 %.mv Date / — —Y 7 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE 0 P( - `? AGEN G t T /OWNER / - 0
DATE
ADDRESS
TELEPHONE #
PERMIT NO. f / .APPL. DATE
ELEC. CONTR. .-LZ -- >��t
OWNER
ADDRESS / d
NATURE OF WORK
ELEC. SERV. NEW CHMGE TEMP
DESC. TYPE VOLTS AMPS
FIX' S 5 �/ --- RECEPT' S
APPLIANCES
SIGNS [ *! i _ '� `g
INSP. ROUGHIN Vie-- 1 SERVICE c INAL
EST. COST / 0 ° PERMIT FEE 5 "DATE PD. 2 "
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