HomeMy WebLinkAbout0023040-Electric (service change) CITY OF OSHKOSH N2 23040
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC. PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 7S / / PLAN NO.
OWNER / : :t NAIL_ .
DESIGNER ACV USE /NATURE OF WORK ? S C)CC2 --
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 5
er c Cr, ,
Electric Serv. New ❑ Change t] Temp ❑ Type 3W /f1e Volts Amps 0: 3 6
Fixtures Switches Receptacles Circuits
91;2--
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 $ O 0 hi Fee Paid $ /0 . / Park Dedication $
ISSUED BY
di.
ISSUED Date 1 7 C ` 2- 2 7 Final /O.Pj 7' — 7/
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUREA%G Z 2-77f
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO . ® rr . APPL . DATE Y / - 7/
ELEC. CONTR.
OWNER A ://i-
ADDRESS //:
NATURE OF WORK pv c •
ELEC. SERV. NEW CHANGE - TEMP. ®p
DESC. TYPE 3 - w - 6 VOLTS /-'7 3162 �S�
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES V
SIGNS
INSP . ROUGHIN S ERVI CE �� -;- F INAL7 -
EST. COST PERMIT FEE DATE PD./ -�/7
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