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Permit #17163 <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 /> ,',............... <br /> u. <br /> s'� H <br /> .. ........ <br /> .... . ..... <br /> Last Name First Name Middle Initial <br /> J® 6 <br /> Ke ii ne-4 <br /> Street Ar ss <br /> 0 <br /> City State Zip Code Telepho e No.(include area code) <br /> I <br /> K ........... <br /> BuildingAddress Subdivision Name Lot# Block# <br /> �aLe AC)LIJ I <br /> Legal Description Parcel No. <br /> SW 1/4, rF 114, Section 24 T 41 N, R 16W E of w 32-5324-01-800 <br /> ............. . . .ACE NT <br /> voi.N <br /> [R11 Family Forced Air Furnace ❑ Radiant Baseboard or Panel(Elec.) 0 Heat Pump <br /> ❑ 2F Boiler EJ Central AC 0 other: <br /> Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 11B -' C3 11 El El <br /> Water Heating 0 <br /> ... ....... <br /> .Ov 40AROM <br /> .................. <br /> ffrS'ite constructed ❑ Concrete Eipivirgs—onry C] Treated Wood <br /> E] Manufactured E] Other: <br /> C.r <br /> . . ....... .. <br /> Livina area $ :'L <br /> Squa e 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 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 /> LT -"'0 1 q C1:S <br /> Applicant's3ibliature Dale Signed <br /> MUST BE COMPLETED B44RE SUBMITTING TO DILHR: <br /> Village ❑ City E] County of: <br /> Town Swiss <br /> Where Dwelling. <br /> :MtJ�N�IrIPALI.T.Y;NIJMBEiR:', :# 0 7 0 0 3 2 Located None <br /> PERMIOPI�� 7/28/93 <br /> - ff ISSUED ISSUfssv.P;�� <br /> Zoning Office <br /> SBD-8254(R.02/90) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />