HomeMy WebLinkAbout0018743-Electric (service change & rewire) � _ CITY OF OSH KOSH N°_ 18743
PERMIT APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC �PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS l O C � . / .� t � S �F" r � � � PLAN NO.
OWNER � -� � n b
DESIGNER
USE/NATURE OF WORK �� �-c1 �
� d� ? - / o �
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 CnNTRACTOR
Electric Serv. New ❑ Change �J Temp ❑ Type���Voltsi�<�- Amps U
Fixtures Switches Receptacles_____�� Circuits _ r�
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
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U ---- O f�
FEES: Valuation $,���� Permit Fee Paid $ �� � Park Dedication $
ISSUED BY Date/� ` ` � �� FinaVO.P.
L
In the performance of this work I agree to perform all work pursuarr, :o rules governing the described construction.
SIGNATURE � `�- � S
� AGENT/OWNER DAT � �
ADDRESS
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