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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wiscon�in�P-7,)— <br /> municipalities for new l- 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)] <br /> Last Name First Name Middle Initial <br /> DeMaster Eugene G <br /> Street Address <br /> 4073 Limonite Lane <br /> City State Zip Code Telephone No. (Include area code) <br /> Eagan MN 55122 651-454-7432 <br /> am`_- <br /> Building Address Subdivision Name Lot# Block# <br /> North Rice Lake Road 3 <br /> Spooner, WI 54801 <br /> Legal Description Parcel No. <br /> — 1/4, 1/4, Section 1 0_T —a_q___N, R 1 4 RjoRW 024-3110-03-520 <br /> ffim <br /> 0&,"j<WINIUM WINE <br /> E9 I Family Ed Forced Air Furnace 0 Radiant Baseboard or Panel 0 Heat Pump <br /> 0 2 Family 0 Boiler 0 Central AC 0 Other: <br /> J WIN <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> IN Ad <br /> Space Heating 0 11 0 0 <br /> Water Heatin 0 51 0 0 0 0 <br /> ®R <br /> I 1_1 EI <br /> * Site Constructed JOC Concrete 0 Masonry 0 Treated Wood <br /> * Manufactured(to the WI UDC;not U.S. HUD code) 0 Other(specif <br /> 'W: <br /> Z <br /> ,RRN <br /> NMI <br /> Living area= 1520 Square Feet $ 204, 000. 00 <br /> 1 vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. I <br /> understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all new I-and 2-family dwellings and must be complied with. I understand that the issuance of <br /> this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> I Applicant's Signatuir) Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> Town 0 Village 0 City 0 County of: <br /> SBD-8254 (R.2/00) Distribution: OPly I-issuing Jurisdiction 0 Ply 2-Mun4ality Forwards to State If New Dwelling OPly3-Applicant <br /> ISSUING JURISDICTION <br />