HomeMy WebLinkAbout0014718-Electric (service change) C41-) _CITY OF OSHKOSH N2 14718
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC ( PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS Nor? 020vY I • PLAN NO.
OWNER w`,' b SA,oic_Li
DESIGNER �/ ,(
USE /NATURE OF WORK ao--)
/.I /�'►C2 cc> A._ ____.
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
Electric Serv. New ❑ Change Temp ❑ Type 34- PA- Volts . 3 Amps / o
Fixtures Switches Receptacles Circuits ‘,,,--
9iD
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 '. 04.03 Permit Fee Paid $ (7201-2) ✓ Park Dedication $
ISSUED BY /A e." ...1 Date 7 ?7 Final /O.P. - X — T `Zy
I
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE - ii: I cic. 7
AGENT /OWNER TE
ADDRESS
TELEPHONE #
PERMIT NO./ 7/ `- - P , DATE / Li — 2 C - „?
ELEC. CONTR. �' �
OWNER ;3 r ;ce' -Z
ADDRESS < (C - -- Pc,;
NATURE OF WORK
ELEC. SERV. NEW " ) CHANGED TEMP.
DESC. TYPE -3, 3 , VOLTS > ,1 1 f e AMPS i e c
FIX'S SW'S ^ RECEPT'S CIRC'S
APPLIANCES GN 9vr '-
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SIS Ca'i"�/
N -. ROUGH N ERVI - - . IN X
COST _ all=figyrjEi
REMARKS
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