HomeMy WebLinkAbout0004865-Electric CITY OF OSHKOSH N2 04865
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1 1 0 vV Cr c PLAN NO.
OWNER—vi M1- Y v V Kt
DESIGNER
USE /NATURE OF WORK ')/L1'4/.--14-(414--
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 F 1 NI 1t— ce 0L. VN . f
Electric Serv. New Change ❑ Temp ❑ Type Volts Amps /0 0
Fixtures x 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 $ /C 0 • Permit Fee Paid $ .S •Cr27 ✓ Park Dedication $
ISSUED BY Date v — L — 2 2 Final /O.P. / -/ 9- eT
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE I'�^ rEa-z.,r. 6- /
AGENT /OWNER DATE
ADDRESS
TELEPHONE #
PERMIT NO. D O ? . P. P _ . ' TE
%!tom _ i I � ,. „
°LEC. CO T•
OWNER
ADDRESS / '.- 7 - ��-
NATURE OF WORK "7-/z-
ELEC. SERV. NEW JS CHANGE TEMP.
DESC. TT I U' — 1.-/- c VOLTS 1 c' AMPS! 0 v
FIX' S *( /JC RECEP 4( CIRC' S X
APPLIANCES 4
N • ROU N tialrt liiirMiii DIM teP!d: Pi� 5►�� ► ✓ -/- ,
EST. COST ! 5"D ' - PERMIT FEE , D ' TE PDS 3 7 , '
REMARKS `�., Ai) /- 4 -44,..
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