HomeMy WebLinkAbout0048253-Electric (service change) �0 3 � `
CITY OF OSHKOSH N° 48253
� PERMIT -
APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS `��� �� 7�. PLAN NO.
OWNER vd'� ��G�[.c��
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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 ❑ Change� Temp � Type� Volt� 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 C I
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FEES: Valuation $ ���' Permit Fee Paid $ -� Park Dedication $
ISSUED BY Date � � �`� �S � Final/O.P.
In the performance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TELEPHONE�M
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� PERMIT NO. . APPL. DATE �
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� ELEC. CONTR. �- 4
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� OWNER f
5 F
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� ADDRESS l�I �" �� �
� NATURE OF WORK �
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� . ERV. NEW O TEMP. �
DESC. TYPE � VOLTS AI�S �
� FIX' S SW'S RECEPT' S CIRC'S �
� LIANCES `
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` S GN `
� INSP. ROUGHIN SERVICE o // J FINAL
EST. COST PERMIT FEE DATE PD.
� REMARKS '
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