Laserfiche WebLink
Wisconsin Pepartment of Industry, WISCONSIN ADMINISTRATIVE Saf?ty 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 /> The information you provide may be used by other government agency programs(Privacy Law,s. 15.04(1)(m)l. <br /> . ... .... ... <br /> ........... <br /> .PERMIT APPLICANT. <br /> �u <br /> Last Name First Name 0 A 0)de K. Middle Initial <br /> waw, A'11% <br /> Street Address <br /> c:2 oo OUlarlook a <br /> 3un <br /> City state Zip Code Telephone No-(i clude area code) <br /> .... .. ... ..... ...... ....... <br /> Building Address Subdivision Name Lot# Block # <br /> -Kc M Oakland Shores 12 <br /> Legal Description 1/4, 1/4, Section 16 40 N, R 16W E or W Parcel No <br /> - <br /> v4, 20-9325—C2-800 <br /> 1. PROJECT TYPE :2.: PROJECT HVAC EQUIPMENT <br /> Ell Family CRTorced Air Furnace F1 Radiant Baseboard or Panel (Elec.) Heat Pump <br /> F] 2 Family E] Boiler E) Central AC E] Other: <br /> 3. PROJECT EN EIRGY SOURCE Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating El ❑ 0 El 1:1 El <br /> Water Heating El El El El El <br /> 4. PROJECT'CONSTRUCTION:TYPE .5. PROJECUOUNDATION <br /> Siie_Constructed oncrete ❑ Masonry 1:] Treated Wood <br /> E] Manufactured E] Other(specify): <br /> 6 PROJECT AREA <br /> 7. ESTIMATED PROJECT BUILDING COST, <br /> Li vi Ing area = 700 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, Chapt rs ILHR 20-25,still applies to all new 1-and 2-family dwellings and must be compiled with. I realize <br /> the issuanc of thi ermitdoes no relieve me of compliance with other applica le cod sanJordinances. <br /> s � <br /> 9 <br /> Applicant's Signature -bate Sii;fned <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION: [Ig Town [I village El city E] County of: Oakland <br /> Where <br /> ,MUNICIPALITY NUMBER: # o 7 - 0 2 0 Located Dwelling EES: None <br /> PERMIT ISSUED BY: Burnett County Zoning 9/19/95 <br /> SBDB 62s4(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yello Applicant <br />