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HomeMy WebLinkAbout040572 - Electric (Change service) 673 f CITY OF OSHKOSH N—° 405 ( 2 PERMIT -- APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC ' PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ADDRESS I I- /7 A I% - z PLAN NO. /, . OWNER tjte- P�C 27 -' 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 Electric Serv. New ❑ Change1 Temp ❑ Type ©//t Volts 3(Xi Amps/de) Fixtures Switches Receptacles Circuits PLUMBING CONTRACTOR BT WH Disp WSoft CBasin Lay Sh DW DF San. Sewer WC FDr SP Ur Storm Sewer Sink LTub Eject SS Water Other FEES: Valuation $ 6 0 , 0 0 Permit Fee Paid $ 3 s-,4) " Park Dedication $ ISSUED BY � _t4,u-zt-._-� Date 0-1A 5 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# t )i ibl, Lott /110144, rPA"V � !Ma N0,PENT 5C. CONTR. OWNER . 44 �` ADDRESS ' NATURE OF WORK TEMP. TEMP �� DESC. TYPE NEW 0 VOLTS CIRC' S DISC. TYPE SW' S RECEPT' S FIX' S APPLIANCES SIGNS NS S SERVICE '7�� i'�eAle- INSP. ROUGHIN PERMIT FEE s DATE PD. / u EST. COST . � REMARKS