HomeMy WebLinkAbout0038149-Electric CITY OF OSHKOSH N2 38149
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC, PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 3/0 'a oaezzfied,
PLAN NO.
OWNER l a- /e.(fi" 4
DESIGNER
USE /NATURE OF WORK
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 l GtI-,tl-rt 1V �..C(,v
Electric Serv. New J. Change ❑ Temp ❑ Type G / 6, Volts3 w Amps _LO .__q
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 $ ;400. 0 0 Permit Fee Paid $ "S" ° o
itif4"--14, Park D edication $
ISSUED BY �Z
Date 'fig $ Final /O.P. 4 -20 -9V
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
p,PPL DATE /�2. �9 �
�tO /6'I -
.
r j'+jll 11 +
E_ C. CONTR.
OWNER !/. � r . Z _ ' /.a 4
ft
ADDRE S
3 OS / ;
NATURE OF WORK d orn ���
C. SERV. NEW CHANGE TEMP.
VOLTS AMPS
• C. .E RECEPT'S CIRC'S
FIX'S SW'S
ANCES
S GN L� �'- f ST. ROUGH N ® 0 PERMIT FEE S: DATE PD. Ems..
EST. COST f
REMARKS
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