HomeMy WebLinkAbout0012473-Electric (service change) � _ CITY OF OSHKOSH No 12473
� PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT .
ADDRESS�� \�,Q� PLAN NO.
OWNER �-- �
DESIGNER
USE/NATURE OF WORK c�� l//CS7� �`� U " � ��l GU (.J �lU •
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 �/ G -
Electric Serv. New ❑ Change � Temp ❑ Type�� Volts��l,CQuAmps�
/
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
� �O
FEES: Valuation $ � Permit Fee Paid $ � �`1 Park Dedication $
ISSUED BY � Date 3 — / —�� FinaVO.P. 3 —1 — ��
In the performance of this I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE �
AGE N �DATE�
ADDRESS
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