Laserfiche WebLink
Permit #20003 <br /> Wisconsilln Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labor and Human Relations BUILDING PERMIT APPLICATION <br /> (Wis.Stats. 101.63(7)& 101.65(3)) <br /> Submit to non-enforcing municipalities for new 1-and 2-family dwellings. <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> The information you provide may be used by other government agency programs[Privacy Law,s. 15.04(1)(m)]. <br /> PRIItT APPLICANT <br /> Last Name First Name Middle Initial <br /> � EIS. AJ I)cDnJAid <br /> Street Address <br /> 3C, x 3210 <br /> City State Zip Code Telephone No.(include area code) <br /> X . <br /> Pto A <br /> Building Address Subdivision Name Lot# Block # <br /> CSM V.3 P.119 E <br /> LegalDescription Gov't Lot 4 Parcel No- <br /> 1/4, 1/4, Section 13 T 39 N, R 14W E or w 24-3113 05-100 <br /> 1: PRoJIrCT TYPE 2.>PRtJ]ET HVAC EgIUIPMI«NTI <br /> 1 Family ❑ Forced Air Furnace Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> PI�OJCT ERI, RGY S(3URCE' Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ® ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ® ❑ ❑ <br /> 4 .PROJ!«C f Cf) ISTRUGTICJN"t YPI: 5. PR£!JE(CT IwQUNDATION <br /> ErSite Constructed ❑ Concrete WMasonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6s PROJECT AREA 7. ES I IMATEp PFtf1ECT Bt#IJ pIN COST <br /> ��// pcS 0 �fJ� �Uo oc <br /> Livingarea = �7 Square Feet $ `7 <br /> I present that all the above information is correct, and understand that the issuance of this permit is for <br /> administrative purposes only. Onsite construction inspections will not and shall not be performed by the <br /> municipality which has not assumed jurisdiction per s. 101.65, Wis. Stats. I understand the Uniform Dwelling <br /> Code, Chapters ILHR 20-25,still applies to all new 1- and 2-family dwellings and must be complied with. I realize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> /v --/S � � <br /> App ica i lure Date Signed <br /> MUST BE COMPLETED BEFOR SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION' 6] Town ❑ Village ❑ City ❑ County of: Rusk <br /> MUNICIPALITY NUMBER: <br /> 0 7 _ 0 2 4 Located <br /> Dwelling <br /> ES: None <br /> PERMIT. ISSUED BY: Burnett County Zoning MATE ISSUED:' 10/10/96 <br /> SBDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />