HomeMy WebLinkAbout0041214-Electric (a/c) 46) CITY OF OSHKOSH:�2i
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELECX PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ?° 7 /77"-1-4-1----.1 PLAN NO.
OWNER 42 '- / 1" ,
DESIGNER OO
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 / G/.ci 4,, -
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
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
FEES: Valuation $ i / - J Permit Fee Paid $ /S ''E'er Park Dedication $
ISSUED BY , /�?% ..-.---, Date °/ Z3 y Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER
DATE
ADDRESS
TELEPHONE #
/ Z
PERMIT NO. M/4 .APPL. DATE (00
E C. CONTR. % ��L
J
OWNER /
ADDRESS / q L-7
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW ' S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUG N SERVICE FINAL/! �'
EST. COST .:1375 5 f PERMIT FEE fr o a DATE PD_. h
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