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Home My WebLink About0021576-Electric (service change) � CITY OF OSHKOSH N°_ 21576 �' PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ZONING FLOOD PLAIN HEIGHT ❑ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDRESS ��%1 PLAN NO. OWNER_ � � I7'10�� `f� . DESIGNER USE/NATURE OF WORK�r {�a'�e �S'C/�(J(.c �..� �/G O � � ��d BUILDING CONl'RACTOR 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 O 'e Yi � Electric Serv. New ❑ Change �emp ❑ Type_� Volts�o Amps GU Fixtures Switches `�� Receptacles �--'�"� Circuits �°"f 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 / v �— FEES: Valuatio $ ! � � � �� Permit Fee Paid $ `�� Park Dedication $ ISSUED BY Date �! �/� �!� Final/O.P. In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNAT R �� —�� /�'O AGENT/OWNER DATE ADDRESS TELEPHONE# � z i .� �,� / � PERMIT NO. . APPL. DATE `�-'� -� � � � ELEC. CONTR. � OWNER - � ADDRESS � / � � �� NATURE OF WORK ` � �� EC. SERV. NEW CHANGE TEMP. D SC. TYPE - � � -�' � - VOLTS � �-Yd AMPS � FIX' S SW' S RECEPT �C CIRC' S ?� � APPLIANCES �l �� SI�GNS � INSP. ROUGHIN ' � - SERVIC=' ` � 13 FINAL � EST. COST / PERMIT FEE ^ ATE PD.� - - � REMARKS �'�`�r �