HomeMy WebLinkAbout0012677-Electirc (a/c) CITY OF OSHKOSH No 12677
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECJ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ) 7Z6 / � sa4, . PLAN NO.
OWNER igj r
DESIGNER
USE /NATURE OF WORK A /c-
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 c
C'', r c-Z -
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches ____lam — Receptacles Circuits -- -- V .-- A9
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 $ /0 0. CDC) Permit Fee Paid $ (�• O 0 " Park Dedication $
ISSUED BY / /AMA /_AL—■ Date -- --• ? ------? Final /O.P. 3 — E7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE CPT ze�i� l - 4-,.--Z7
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. ! .APPL. DATE
ELEC. CONTR. joilline _ 1v
9,
OWNER
/ Yy�
ADDRESS
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
D_F$C. TYPE VOLTS AMPS
FIX'S SW'S (7" RECEPT'S CIRC'
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL i j i?
EST. COST / PERMIT FEE / DATE
REMARKS
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