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HomeMy WebLinkAbout0005159-Electric (service change) /� CITY OF OSHKOSH N° 05159 `' PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC � PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDRESS � PLAN NO. OWNER DESIGNER USE/NATURE OF WORK BUILDING CONYRACTOR Size Sq. Ft. # Rooms # Stories Height Foundation Class of Const. Occupancy Permit HEATING CONTRACTOR Heat ❑ A/C ❑ Vent ❑ Fuel/5ystem Heat Loss BTU'S P ELECTRIC CONTRACTOR Electric'Serv. New ❑ Change �mp Typ���Volts/ �Amps,�t� 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 FEES: Valuation $ D� Permit Fee Paid $ ���/ Park Dedication $ ISSUED BY Date � �/ ' �7 Final/O.P. [� � ��a —D 7 In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE � AGENT/OWNER DATE ADDRESS TELEPHONE# . � PERMIT NO. � �! � APPL. DATE � �� -�� ELEC. CONTR. �£�' �Lz OWNER l� ` ADDRESS ���� � ��" NATURE OF WORK ELEC. SERV. NEW CHANGE TEMP. DESC. TYPE � �� - �L/ VOLTS z- �- O AMPS O FIX'S SW'S RECEPT CIRC'S� APPLIANCES . SIGNS INSP. ROUGHIN SERVICE�,�C��= ' � '�'ZFINAL� -.%�f� EST_ COST �0 � PERMIT FEE ,.- ..5��DA?E PD�`�7-n7 REMARKS