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HomeMy WebLinkAbout0016700-Electric (service change) 40) _CITY OF OSHKOSH N° 16700 PERMIT APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC s tK PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS • = , /- ! --� PLAN NO. OWNER A G DESIGNER USE /NATURE OF WORK vv . - 6 r 1 - 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 i ELECTRIC CONTRACTOR ...1i _ 7 doe, Electric Serv. New ❑ Change 0 j Temp ❑ Type 3_ VoI12Ass) Amps 7 Fixtures Switches Receptacles Circuits K 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 G a v FEES: Valuation $ © Permit Fee Paid $ �® Park Dedication $ ISSUED B ' / /L �� / Date/. ' ' Final /O.P. 1 / (7 � — 8, 1 In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE � �T/i� .�-' /�/ c�' AGENTIOW TE ADDRESS TELEPHONE # P - T NO. 1 / ! .r(/ . APP . AT ' / - j D —� ELEC. CONTR. C/ / )4 OWNER 1 °(a'Q1 67 ADDRESS / T3 7 ' NATURE OF WORK ELEC. SERV. NEW CHANCE /2 TEMP . O a . _ tar'E -- C> 1! ‘.---- lm '' V* LT s ss. AMP FIX S SW'S RECEPT' CIRC'S APPLIANCES a, SITS SERVICFD /'S / y` F INAL /- ' INSP , ROUGHIN c d cc ' ' DAT - D . - -- COS_ O• REMARKS ' r