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Home My WebLink About0021862-Electric (service change) /� CITY OF OSH KOSH N° 21862 `' PERMIT - APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC (�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ' - - - - - - - - - - - - - -��I - - - - - - � - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDRESS ��v'� PLAN NO. OWNER � DESIGNER USE/NATURE OF WORK �� 1' l G�� 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 cCCL G cf Electric Serv. New ❑ Change�Temp ❑ Type� Volts� Amps�� Fixtures Switches Receptacles Circuits L� 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 s FEES: Valuation $ �'°` Permit Fee Paid $ ��-� Park Dedication $ ISSUED BY Date,/,�� Final/O.P. �,�_� �� — �� In the performance of this work I agree to perform all work pursuant to rules governing the described construction. SIGNATURE �� C- � " �� ,/� �� AGENT/OWNER DATE - - ADDRESS TELEPHONE# Q �--- - _ � PERMIT NO. � G' � • APPL. DATE � � 1� ELEC. CONTR. - � OWNER . � ` l" . i ADDRES:, � � NATURE; OF WORK / �-- � ELEC. SERV. NEW CHANGE TEMP. DESC. TYPE � G� -' G ' VOLTS y� AMPS•-zG�O FIX' S SW' S RECE ' S CIRC' S APPLIANCES �' SIGNS � �' INSP. ROUGHIN SERVIC��i�`II'� ' Z FINAL " -/ � EST. COST �tyC�-`�' PERMIT FEE� = DATE PD.I -��-D [ REMARKS �U-- � � ��