HomeMy WebLinkAbout0012176-Electric CITY OF OSHKOSH No 12176
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS I 1 Z (,J (7 1 PLAN NO.
OWNER t re
DESIGNER
USE /NATURE OF WORK Ki k . R 1/' -lK'62--
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 L) 1 I L- E-- E T IC f C--
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches X Receptacles X Circuits ID<
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
G V
FEES: Valuation $ t% d G`- Permit Fee Paid $ 3l �/� Park Dedication $
ISSUED BY `�t9�L _ Date / ' ' `� / q Final /O.P.
/
In the performance o the work I are to perform all work pursuant to rules governing the described construction.
SIGNATURE 1\ 1 - Z4—AS- 9
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. / � l 7 4
ELEC. CONTR. L I L. DATE
OWNS ii ._ 4.., g-- • NATURE OF y,, / '� � ��t
WORK (..c.--' _
E EC. SERV. iMird r
DESC. TY NEW i _ g.
FIX'S CH
APPLI SW' S '
.�CEPT� VO TEMP
S
SIGNS c=<-__ _____ CIRC' -�
INSP.
REMARKS COSTGHIN / rIij' <
MARKS SERVICE
PERMIT FEE 3 .� = FINAL
D ATE PD -zv- 'Y
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