HomeMy WebLinkAbout004862 - Electric (AC) CITY OF OSHKOSH N° 04862
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS 1Oi Mt-
Y t ri o rl PLAN NO.
OWNER 0 ar CC
DESIGNER f
USE/NATURE OF WORK AJCI-
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
C'
ELECTRIC CONTRACTOR (C nit CC C `JY"
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits `l
i,X".1-----
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 $ OO.CD Permit Fee Paid $ cl. Park Dedication $
ISSUED BY 1/12- Date(J —7 — K.2 Final/O.P. —Y
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE (41-5 s„, (,.__,-
AGENTOWNER DATE
ADDRESS
TELEPHONE#
c . 7.. 7
�JATET
APP
pERMIT
r / :
ELEC. coNT 4r
t , ,
OWNER '
Pr
ADDRESS --
NATURE OF WORK OF
CHANGE TEMP.
ELEC. SERV. NEW �pL,I,S AMPS
FIX' TYPE RECEPT' S CIRC' S '
FIX'S SW' S
APPLI__LCES
SIGNS SERVICE FINAL zi
INSP. ROUGHIN pERMIT FEE --DATE PD. ',`
EST_ COST
REMARKS
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