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-#-- , <br /> Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new I- PERMIT APPLICATION Safety and Buildings Division <br /> and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) <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 /> ` 'EIT,AI�PY.IANT <br /> Last Name First Name Middle Initial <br /> �XJ6t' 7110A, j4s <br /> Street Address <br /> 55.3 Oe7-Ue <br /> City State Zip Code Telephone No. (Include area code) <br /> /)EW '5`10 1 7/5'c-2 4/� 60 5 3 <br /> 040 <br /> Building Address Subdivision Name Lot 7u Block# <br /> a-] 3L/3 C- , pEu_rLs LAKEL-0-r 2, 0_!5MVi P 191 /8 <br /> TOW0 of C)14KLUO <br /> Legal DescriptionC:) I Parcel NO. <br /> 1/4, — 1/4, Section -3 � T N, R E or <br /> 7 <br /> 1, PROJECT T,,,) �#V EQUI�T ,T, <br /> TE <br /> yC <br /> �Nj <br /> I Family Forced Air Furnace 0 Radiant Baseboard or Panel 0 Heat Pump <br /> -0 2 Family 0 Boiler 0 Central AC 0 Other: <br /> X,ENERGY,$OIJRC1&' Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 <br /> Water Heating 0 <br /> 4. CONSTRUCTION TYPE 5.FOUNDATION <br /> XSite Constructed A Concrete 0 Masonry 0 Treated Wood <br /> t] Manufactured 0 Other(specify): <br /> 6.AREA 7. ,ESTIMATED BUILDINGCOST <br /> Living area= If-1177 Square Feet $ YO/ 0(DO <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 /> Chapters Comm/ILHR 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I understand that the <br /> issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> e=ve <br /> Applicant's Signature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> 0 Village 0 City 0 County of. <br /> ISSUING JU P !1Town <br /> MUNICIPALITY,N I UMBER: # <br /> of Dwelling Location L) ;FEES:" , <br /> PERMIT ISSUEDBY: <br /> gDAT 7E <br /> UI,L�tt ( <br /> V <br /> SBD-8254 (8.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />