HomeMy WebLinkAbout893 ELEC (Service)ti_ �r
' , R . e :&
AFFIDAVIT BELATiNG TO SE�TION 13.12 {c) OF A GENEAAL OI�DINANCE
{iF THE CZTY 4F OSHKOSIi RELATING i(3 THE LiCENSING flF ELECTBICIANS
AND PFiOVIDING PENALTIES
STATE C+F WISCONSIN}
) SS
WTI�NEBAGO COUNTY )
, � 1 �' ��>--� -�� •
Nams Addres� ..
first being duly sworn on oath, depases and sa.ys tha.t he is not
a l�icensed eleatrician in the City of Oshkosh and that he has
applied for an electrical permit to do electrfcal work in a
residence and/ar auxiliary buildings (intended soiely for pur-
poses associated wi.th a residence} whieh is oxmed and accupied
by him, ar is bein� constrUcted in his name, as his personal
homs anci that sa,id residence ar auxlliary bulldings being so
wired are no� �o be used or erected for renta2 purposes ar #'or
resale ta present or praspective purohasers.
Afflant understands that the electrical wark autharized by
the permit app].ied for in cpnnection w3.th this affidavit� must
be done only by this affiant and �hat he canno� employ others to
assist with �he electrical work but members of his immediate
fa�ily.
Dated �his � day af , 19�
Subscribed
thi s ,���-
and sworn ta befare
._ ,
Notary Public, Winnebago County9 Wi�cansin
�t�tY COMMiSSION EXAIRES
Nfy Commiss3an Expires; �u�-Y��, 3.�s1
���%�-��