HomeMy WebLinkAbout0013510-Electric (a/c) CITY OF OSHKOSH N2 13510
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC 'PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ( 737 li . Sa m . PLAN NO.
OWNER Ars, S _
DESIGNER
USE /NATURE OF WORK A7 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 5 -
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
4 :1—
Fixtures Switches (� Receptacles Circuits
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 $ /,e) le Fee Paid $ le) Park Dedication $
ISSUED BY AA ,► - i ✓ Date .5 - -- 77 Final /O.P. S _ ZZ -7 7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE Ci -e----Lc_ J/�
AGENT /OWNER AO TE
ADDRESS
TELEPHONE #
LEMIT NO. 71/ D . APP . D TE
E C. CONTR. ,..A16-...4,17' ---/--e--'
OWNER
N • IE_ OF WORK
CHANGE TEMP .
4 __ ERV. NEW Via, S ` MPS
E
F X' S SW' S RECEPT'S CIRC'S
e.,
APPLIANCES
r ERVICE FIN _ , �
N. - OT H N r -DA -D. 2.'
I CO T 0 A RM T FEE
REMARKS
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