HomeMy WebLinkAbout0028403-Electric CITY OF OSHKOSH N°_ 28403
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC, PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
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ADDRESS Q — - / PLAN NO.
OWNER - ° -
DESIGNER
USE /NATURE OF WORK (e.0-721
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 `J -D /Itil�
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps 4 11P Fixtures Switches v 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
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FEES: Valuati.n $ / / Q d d --' Permit Fee Paid $ / � p � Park Dedication $
ISSUED BY /✓6 .,, ..../ Date 5 — 4 % - . Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE RCP 4-Q0 3 9 Z
AGENT /OWNER DA
ADDRESS
TELEPHONE #
PERMIT NO.� O
APP . DATE
C. CONTR. 0 4111Mir
OWNER - - V //
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NA - . OF WORK ��� � ,;�
CHANGE TE �
RV N VOL *4 �� CRC'
F X'
N . `OUe 2 MF IIIIWTE.a R � , , D. -T2
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