HomeMy WebLinkAbout0043341-Electric (service change) (v.J �,
No�- � 43341
� CITY OF OSHKOSH i :
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT :
�
ADDRESS J 3 � PLAN NO.
OWNER :
DESIGNER
USE/NATURE OF WORK '
BUILDING CON7RACTOR
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 j$� Temp ❑ Type d� Volts � � Amps/�
i
Fxtures 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 $ � �� • E' � Permit Fee Paid $ �U•� � Park Dedication $
ISSUED BY Date�/y � 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 rE�EPr�o�vE�