HomeMy WebLinkAbout0044680-Electric (remodel) �O ��
CITY F SHKOSH N° 44680
n O O
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC�PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS �2 � �` (<t�/������(i'-1-.[,C.�^� PLAN NO.
OWNER c��—��
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
ELECTRIC CONTRACTOR L�v!'�a1/1i
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fi�ures �� 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 $ +��0 � � '� Permit Fee Paid $ <�p� o � Park Dedication $
ISSUED BY ^ Date 'y��b/�J/ FinaUO.P. �����L—
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 N
PERMIT NO. ����� . APPL. DATE
ELEC; CONTR. y
t
OWNER
ADD�tESS � � �� ,��_ Z. 3 �� � .5��2
NATURE OF WORK
ELEC. SERV. NEW CHANGE TEMP.
DESC. TYPE VOLTS AMPS
FIX' S SW' S RECEPT' S CIRC' S
APPLIANCES
SIGNS
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INSP. ROLTGHIN SERVICE FINAL 5
EST. COST c : r , 4 o PERMIT FEE �Sc, c; ::� DATE PD. � 5 ���
, . _. .t. REMARKS
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