HomeMy WebLinkAbout0042087-Electric (temporary) �S�
CITY OF OSHKOSH N� �2087
� PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS ��S//'� � /�'/ PLAN NO.
OWNER
J�-� ,
DESIGNER
USE/NATURE OF WORK
BUILDING CON7RACTOR
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
Electric Serv. New ❑ Change ❑ Temp� Type��L Volt�� 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
FEES: Valuation $�� • � Pe�mit Fee Paid $ / �� � Park Dedication $
ISSUED BY Date ���i�g `� Final/O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATUFiE
AGENT/OWNER DATE
ADDRESS
TELEPHONE M
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� PERMIT NO. 7'��� . APPL. DATE �
ELEC. CONTR. .��/-��'
UWNER �°z��z°j/
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'P�DRESS �"�S�!/. f��t.�-
lYr,"�VRE OF WORK
ELEC. SERV. � NEW CHANGE �
DE�C. '1'YPE a�/ VOLTS uJ A1�S�/i�
� FZX' S SW'S RECEPT'S CIRC'S
AP_P__�IANCES
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� SIGNS
� . ROU N ER CE F N
� ��2. COST ��8� PERMIT FEE siS:o� DATE PD a /z y y
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