HomeMy WebLinkAbout0016176-Electric (temporary) CITY OF OSHKOSH
N2 16176
PE RMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS z 1 --'1
c� l / PLAN NO.
OWNER V
DESIGNER
o
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 -GC. -----y '
Electric Serv. New ❑ Change ❑ Temp / Type / 4o112 Amps1 Al •
Fixtures Switches Receptacles Circuits K ; ∎ `' '-
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 $ ? , 42 -- Permit Fee Paid $ / ®`� Park Dedication $
ISSUED B Date /7 E7 Final /O.P. /& " k y
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE �r � / �/ L r
:Uc , T /OWNER DATE
ADDRESS
TELEPHONE #
PERM T NO. I/ 7 APP . DATE l e J - 7 7
ELEC. CONTR.
OWNER gj, /
ADDRESS
NATURE OF WORK
ELEC. SERV, NEW CHANGE TEMP. P
DESC. TYPE VOLTS ' O AMPS , O
FIX'S SW'S RECEPT' S v< CIRC'S
APPLIANCES
SIGNS 646440
INSP. ROUGHIN _---- SERVICED[& - /t' �� 1� 1 FINAL /0'5 ,Fc•
EST. COST 5 0 PgRMIT FEE JO % DATE 1DI /
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