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HomeMy WebLinkAbout0019661-Electric (service change) � _ CITY OF OSHKOSH N° 19661 PERMIT APPLICATION AND RECORD TYPE: BLDG ❑ HTG ❑ ELEC � PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ADDRESS�?�I�W�1�l� PLAN NO. OWNER � (�3—���S�C�-ti.� DESIGNER USE/NATURE OF WORK D� � - ) - U G. '7� 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 CONTRACTO Electric Serv. New ❑ Change � Temp ❑ ��..yTyp����olts,,�— Amps�C� �' � 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 � O � FEES: Valuation $ D� `—�Permit Fee Paid $ �� � Park Dedication $ ISSUED BY Date �,�� `` � Final/O.P. — Z 3``� In the performance of t ' k I agree to perform all work pursuant to rules governing the described construction. SIGNATURE �'t„��O AG /O NER DAT� ADDRESS TELEPHONE# i � �j / `� ' PERMIT NO. l �" � / . APPL. DAT '^� � � ELEC. CONTR. � � �`'� ' � OWNER ""L -'�"����"�*�_ ADDRESS ` � g `' �-��L� NATURE OF WORK _ ELEC SERV NEW CHANGE °'� TEN�. DESC TYPE a �, � �.t- � w VOLTS l �-"itio AMPS !�' C' FIX' S SW' S RECEPT' S D�. CIRC' Sv� APPLIANCES V . ,� SIGNS INSP. ROUGHIN SERVICE - Z3- ` �' FINAL �-� 3�`� ' EST COST �{Od� PERMIT FEE .ZO`=- DATE PD:7^3��9� REMARKS