HomeMy WebLinkAbout0004173-Electric CITY OF OSHKOSH N2 04173
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC �PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS / 5 C.
PLAN NO.
OWNER
DESIGNER
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 4- "` e -gg.-•—
Electric Serv. New [Change ❑ Temp ❑ Type Volts Amps
Fixtures 4.--- Switches Receptacles ` Circuits `�
kg" (
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW , San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
42 . FEES: Valuation $ / 42-°0 Permit Fee Paid $ v f Park Dedication $
ISSUED BY Date 6vl l''ff/ Final /O.P. 7 - -
In the performance of this • I agree to .erform all wor pursuant to rules governing the described construction.
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SIGNATURE
GENT /OWN " ' DATE
ADDRESS
TELEPHONE #
PERMIT NO. 4 l 7 -3 APPL. DATE , -77
ELEC. CONTR. 1:de,
OWNER / z ? i
ADDRESS / , 3 3( — !�/ c a— lam •
NATURE OF WORK ,mac ^"...rc-1---jo
ELEC. SERV. NEW, CHANGE TEMP.
DES C. TYPE- (/- - /j VOLTS / - 3 v d AMPS 2 CYO
FIX'S ,5 (,I/ 1C RECEPT' Vp. CI RC' S)<
APPLIANCES n „
SIGNS i 7 M
INSP. ROUGHI / /G 7 SERVIC S , /1 6 ' FINAL'J 8'g)
EXT. COST / 0e) �_ PERMIT F ATE PD i ii
n 6 T
REMARKS
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