HomeMy WebLinkAbout0040567-Electric (circuits) l�/�
� CITY OF OSHKOSH
N°_ 40567
`' PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING - _ FLOOD PLAW - _ - HEIGHT
ADDRESS Z� PLAN NO.
OWNER
DESIGNER
USE/NATURE OF WORK
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
.
FI FC`TRI[` C'(�NTRA('TnR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts 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 $ �U•o'`J Permit Fee Paid $ �• ° � Park Dedication $
ISSUED BY Date Z � � Final/O.P.
In the performance of this work I agree to pertorm all work pursuant to rules governing the described construction.
SIGNATURE
AGENT/OWNER DATE
ADDRESS
TELEPHONE#
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PERMIT NO��SSG� � . APPL DATE L�'I/�Z/`t SG
ELEC CONTR -s��-'"`�
OWNER C�x.�-t��__ •� '' ���
�,DDRESS �Z'� � /"�,-��'�
NATURE OF WORK
FT EC SERV NEW CHANGE 'TEMP•
DESC TYPE VOLTS AMPS
FIX' S SW' S RECEPT' S CIRC' S
APPLIANCES �„`'.
S I�GNS
INSP. ROUGH N SERVI CE F IN `�ti �_
EST COST 0 0 v c� PERMIT FEE /�•��� DATE PD. � �r �%y�
REMARKS
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