HomeMy WebLinkAbout0011389-Electric (service change) CITY OF OSHKOSH N o 11389
PERMIT — APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC/' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS i 3 V U - "
�I PLAN NO
` p r
OWNER y 14x0" For
DE E
USE /NATURE OF WORK 3 e.4.) CO 6 S c�•J t l (9 O
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 /at ,_ f / _ ...-A
Electric Serv. New ❑ Change Temp ❑ Type 3 Q Volts 1 701 Am s C'
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
el 6
FEES: Valuati.n �: a ----'— a
$ /) Permit Fee Paid $ Park Dedication $
ISSUED BY y( Date// `) - `Y Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE ' .. °— % 1 V � dier AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. / / 3 F APPL. DATE l
ELEC. CONTR.
OWNER
ADDRESS V3 6
NATURE OF WORK
ELEC. SERV. NEW CHANG TEMP.
DESC . TYPE :3 - ( 3 -VOLTS AMPS! OU
FIX'S SW' S RECEPT' S DEC , CIRC
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL
EST. COST 5 r f PERMIT FEE DATE PD / -
REMARKS