HomeMy WebLinkAbout0021509-Electric (service change) (41) CITY OF OSHKOSH N9 21509
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS /� 7 3 t
� PLAN NO.
OWNER / ?V�
DESIGNER
USE /NATURE OF WORK
C-' e-� - 4-4-C✓
3 - R, 5 (c d
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 li.. a _ te r - /
Electric Serv. New ❑ Change O Temp ❑ Type Volts `g Amps /0
Fixtures Switches Receptacles —_—X.,_ 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 $ Qp ' --- Permit Fee Paid $ 1> --�- Park Dedication $
ISSUED BY Date // `9e9 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE / 14/44-4....7G" 71 7
AGENT /OWNER DATE
ADDRESS
TELEPHONE #