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Home My WebLink About0003158-Electric (add receptacles & circuits) � , CITY OF OSH KOSH N° _ 03158 PERMIT - APPLICATION AND RECORD . TYPE: BLDG ❑ HTG ❑ ELEC� PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDRESS_�"7�( � � ]'!�� !�1�� PLAN NO. OWNER 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 - i �— Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts 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 , I FEES: Valuatio $ d �— Permit Fee Paid $ �� Park Dedication $ ISSUED BY Date � —�./"��,� Final/O.P. ��T=� In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE o�� /�� T/OWNER DATE ADDRESS TELEPHONE#