HomeMy WebLinkAbout0016697-Electric (temporary) CITY OF OSHKOSH N2 16697
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC [t PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ".3 ® PLAN NO.
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OWNER 74/
DESIGNER / 7 �
USE /NATURE OF WORK Q ,/ A .. 3 �^ �' `
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 Gv A--V fg-e-¢ -- ,)
Electric Serv. New ❑ Change ❑ Temp A'1 Type Volts/A= Amps 16 U 1Q--°'
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
-rte ��
FEES: Valuation $ J Z, Permit Fee Paid $ / //� Park Dedication $
ISSUED BY , Date / - 1 /' ?? Final /O.P. ` °•O ' Y7
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE /� 4e,
AGENT /OWNER D
ADDRESS
TELEPHONE #
PERMIT NO. Y . APP DATE /e
/ /
FI C. CONTR. w �A /
OWNER `/
ADDRESS P ` 3 5 —
NATURE OF WORK
ELEC. SERV. NEW CHANGE y /yMP.
DESC. TYPE w — VOLTS I �0 AMPS SW 'S � RECEPT1 (=.( CIRC'S o<
APPLIANCES
s rGNs t 2 )
INSP . ROUGHIN SERVICE : / - -.? 1 - 7 F INALP) e
EST. COST ro PERMIT 1EEle ° - DATE PDIa - j9
REMARKS