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O� 7 <br /> Submit 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 YELLOW COPY. <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> PERMIT.APPLICANT' <br /> Last Name First Name Middle Initial <br /> Street Address / <br /> //� 7 La4k3( C'l <br /> City� ��` State <br /> y7� Zip Code Telephone No. (In_clude area cod�o <br /> =PHO T LOCATIf1N <br /> Addres S division Name __[L7# B- <br /> Buildinglock# <br /> 547 s�om Lala j �l�vay h G r:•�„ i ''A <br /> r Sy9_5o a o tl;lltvqr <br /> Legal Descripti n Parcel No. <br /> 1/4, 1/4, Section 0 T J/0 N, R E or W <br /> I, 'PRO.IECT TYPE-," „ �,JWAC 4VVIPNENT <br /> 1 Family T!1:Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> 3 E+NEiRGY,"S(��{CEi Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ , ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ;Er ❑ ❑ ❑ ❑ <br /> 4. CONSTRUCTION TYPE 5.FOUNDATION <br /> PKSite Constructed Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6.AREA 7 ,ESTIMATED BUILDING COST <br /> Living area= c j Square Feet I $ �Ql� Q�Q a� <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 I-and 2-family dwellings and must be complied with. I understand that the <br /> issuanc f this pe s n ve me of compliance with other applicable codes and ordinances. <br /> Co <br /> Applicant's Signature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISI®N OF SAFETY AND BUILDINGS <br /> ISSUING JURISDICTION Town ❑ Village ❑ City ❑ County of- <br /> MUNICIPALITY NUMBER: # 7 - O O )FEES: <br /> of Dwelling Location <br /> PERMIT ISSUED BY: ATEDg' s <br /> IS$t 'D. `T <br /> SBD-8254 (8.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />