Laserfiche WebLink
Permit #16169 <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. See instructions on back of yellow copy. <br /> .. ............. ... ... .......... <br /> !T!r" <br /> Last Name First Name Middle/Initial <br /> r-L)OL _ <br /> Street Address <br /> 0-F G/�, 'i /,-�L'dt'. <br /> Cit state Zip Code Telephone No.(include area code) <br /> 0ZlT <br /> :5 5047 <br /> ON �x <br /> Building Address Subdivision Name Lot# Block# <br /> q_7? tion <br /> 16 <br /> �/ P 021 Park Addition Urr A.4 <br /> Legal Description Parce No. <br /> 1/4, —1/4, Section 2 T 38 N, R 14W E or W 08-9075-02-400 <br /> ................ <br /> .............. <br /> [T1 Family UkTorced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) 0 Heat Pump <br /> n 2 Family E] Boiler E] Central AC ❑ Other: <br /> Nat-Gas L.P. oil Elect. Solid Solar <br /> Space Heating 0 0 ❑ 13 0 <br /> Water Heatin2 0 0 0 1:1 0 <br /> "PRO <br /> J1ECT CONSTRl7CTIQN <br /> PIE 5,RRf)IE Y>OUNDATIQN <br /> Site Constructed C] Concrete Masonry C] Treated Wood <br /> Manufactured ❑ Other: <br /> PROJECTARE <br /> NG.,C <br /> I COST, <br /> T <br /> Livinq area -78- D0 Square Feet <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 11-and 2-family dwellings and must be complied with. Irealize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> \V\ o , Dw� q -, z � — 9 -Z, <br /> Applicant's Signature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> Is <br /> UIUMOMRISDICTIOW [0 Town ❑ Village ❑ City Of: Dewey <br /> # <br /> _a LL <br /> NICWI". W N4A <br /> MU <br /> .:P R111ii IS <br /> SY990,BY, K.;� Zoning Office 9 <br /> SBD 8254 IN 09/89) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />