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..,abt,_a to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new 1- 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 SECOND PLY <br /> Personal information you provide may be used for secondary purposes. (Privacy Law 15.04(1)(m)J <br /> vf xik <br /> +a r � �e'br` °"' t <br /> 4.:.`. <br /> Last Name First Name Middle Initial <br /> ,Tahr,s ons �ARRYL lP . <br /> Street Address <br /> 66V 6J /sG0alsi�✓ <br /> City State Zip Code Telephone No. (Include area code) <br /> Ala <br /> Building Addre s Subdivision Name Lot# Block# <br /> L X77 5 /» V9 Pl63 <br /> Legal Description Q p, /, Parcel No. <br /> 1/4, 1/4, Section �fJ T 3fJ N, R I7 E or�W� �8 -p7��8 by Jr� <br /> w <br /> Fa <br /> " P � x�e � � ���� �' es^"wbx� @..,s,fi rx•a. <br /> W 1 Family ❑ Forced Air Furnace J9 Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> 3;E`NI?RG � h WF 40"t Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ j� P9 ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> 4:CANS 9 o-, ; � 4`� NDATION <br /> -. �` . . . - <br /> Site Constructed Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6.AREA'- D <br /> 2 (�O <br /> Living area 674 Square Feet S d d 000e <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 /> ante of this permit do s no relieve me of compliance with other applicable codes and ordinances. <br /> Cz. 161-97A2 <br /> Applicants igna re Date Si ed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> ISSUING JURISDLCTION: Town ❑ Village ❑ City ❑ Countyof: <br /> w � <br /> MUNICIPAL,ITY <br /> 6fDwelling Location ' "4 <br /> PERMIT ISSUEh<ABI <br /> 0,40 �1, <br /> SBD-8254 (R 4/99) <br /> ISSUING JURISDICTION <br />