HomeMy WebLinkAbout0006976-Electric (service change) �
� CITY OF OSHKOSH N° 06976
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PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS��7—� �' I ����— PLAN NO.
OWNER �T�/' �e-�PYY�y
DESIGNER
USE/NATURE OF WORK �Y�V�� �-'�� 'T- G� '�O L� "" �� ��• ��
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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 vC�C
Electric Serv. New ❑ Change [� Temp ❑ Type f�• ��'"� Voits�!.��30 Amps��
/
Fixtures Switches Receptacles Circuits
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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 $ � �`�� Permit Fee Paid $ � Park Dedication $
ISSUED BY Date � �—���— FinaVO.P.� � `
In the performance of this wor I ree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGE OW R DAT
ADDRESS
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