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Sqbmit t() non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new 1- PERMIT APPLICATION Safety and Buildings <br /> and 2-family dwellings (Wis. Stats. 101.63 (7) & 161.65 (3)) Division <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> PERMIT APPLICAI�TT!. <br /> 7 7: <br /> Last Name First Name Middle Initial <br /> 'Ta4a- R-xlep-A'-5 <br /> :1-6 1 A Jq bi I <br /> Street Address <br /> Ci ty State Zip Code Telephone No. (Include area code) <br /> /Aj -5 -�s 5-(n <br /> L <br /> -PR <br /> OJET... CATION <br /> Building Address Subdivision Name Lot# Block# <br /> WVX's V l 3 P 4-7 <br /> Legal Description Parcel No. <br /> 1/4, 1/4, Section 2(o TN, 0 C) <br /> N, R EorW 03 <br /> PROJECT TXPE 2.PROJECT OMMQUMMENY <br /> I Family Forced Air Furnace 0 Radiant Baseboard or Panel ❑ Heat Pump <br /> 11 2 Family ro Boiler 1-1 Central AC I] Other: <br /> PROdLi i4RC Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating D E] ❑ <br /> Water HSaft <br /> JIT M, <br /> ,4 ONSTE CTjQ':L <br /> FOU 10" <br /> AT <br /> piSite Constructed LV Concrete LJ Masonry 0 Treated Wood <br /> 0 Manufactured 11 Other(speci6 PROJECT AREA fy): .. ..... ....... <br /> "7 <br /> E TL LE..0 R0JEZ7-. <br /> %BUILDGLCOST <br /> Living area= (9- Square Feet $ (9-0 14 Lx)nc:) <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. <br /> I understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapten Comm/ELHR 20-25,still applies to all new I-and 2-family dwellings and must be complied with. I understand that the <br /> L <br /> issuanoe this permit 4D s not relieve me of compliance with other applicable codes and ordinances. <br /> 2A i 9 <br /> ApphcantSignaWwrj <br /> Date Si edV <br /> MUST BE COMPLETED BY THE MUNICIP EFoRE FORWARDING PINK PLY TO THE STATE DWSION OF SAFETY AND BUILDINGS <br /> MDI! <br /> Town <br /> C 11 Village 0 City EJ County of <br /> py SATE TE:... <br /> t.Itr <br /> vin 1.1 <br /> � ?the C /�'1 SUED. <br /> SBD-8254 (ROM White-Issuing Jurisdiction Pink-State WiWn 30 Days Yellow-Applicant <br />