HomeMy WebLinkAbout0045105-Electric (a/c) 4.1) CITY OF OSHKOSH N ° - 45105
PERMIT - APPLICATION AND RE
RECORD
TYPE: BLDG ❑ HTG ❑ ELEC XPLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS • PLAN NO.
OWNER /
DESIGNER
USE/NATURE OF WORK t ^ 4.
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 1 - ..
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 $ (0 0 • o Permit Fee Paid $ O • 4 " ) ' ° Park Dedication $
ISSUED BY E Date 572- -W�! -1 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 #
PERMIT NO. V .APPL. DATE
ELEC. CONTR. ,(J
OWNER ) (47z " -
ADDRESS /7 .' - ° --
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX'S SW'S RECEPT'S CIRC'S
APPLIANCES
SIGNS
INSP. ROUGHIN SERVICE FINAL
EST. COST /0 PERMIT FEE /0 DATE PD./-V(?
REMARKS