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Permit 4620245 <br /> Wisconsin 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 maybe used by other government agency programs[Privacy Law,s. 15.04(1)(m)I_ <br /> PER APPLICANT <br /> : <br /> Last Name I ' First Name Middle Initial <br /> 7 IPV 3b[.� � � . <br /> Street Address�z, <br /> City State Zip Code Telephone No (include area code) <br /> 5 �►�e.r+. ti'�f i,s <br /> 5`1Sl-7 -1 15- 3�l9 - S z 3f <br /> PEtIJI~CT Lq>~AI IiQIN <br /> Building Address <br /> 2�Z89 �4S _ ,n Lot Block# <br /> t(_ <br /> Subdivision Name <br /> evil KJ -C3a Colter's Sub. of Lot 2 <br /> WI -5 & 10 1 <br /> Legal Description I Parcel No. <br /> 1/4, 1/4, Section 34 T 40 N R 16W E or w 20-9100-01-200 <br /> 9 PROJECT .TYPE 2. PR�3JEGT NYAC Et�UIRMENT i <br /> 1 Family Forced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pum <br /> 2 Family p <br /> ❑ y ❑ Boiler entral AC ❑ Other: <br /> 3:>PRO :Et"i ENERGY SOURCE is Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> 4, PROJI« CC©N'STRUCTI7NYPI» Sw. PRt I' CTFOVNOATION <br /> Site Constructed ('Concrete ❑ Masonry ❑ Treated Wood <br /> Manufactured ❑ Other(specify): <br /> 6. PROJECT AREA 7, ESTIMATED PROJECT UILDIN6 T <br /> Livinq area = q Sfd Square Feet g D s d6 0 <br /> 1 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. [ realize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> Q,a,, , V!/14fg7 <br /> Applicant's Ignature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION: Q Town ❑ Village ❑ City ❑ County of: Oakland <br /> MUNICIPALITY NUMBER' where Dwelling <br /> 7 0 2 0 Located ES' None <br /> PERMIT ISSUED BY: Burnett County Zoning Office DATE ISSUED 4/24/97 <br /> SBDB x254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />