Laserfiche WebLink
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 /> I'EI�NII'T '1!'Ll<CANT <br /> Last Name First Name Middle Initial <br /> Street Address <br /> 6640 7'0..> v� �o <br /> City State Zip Code Telephone No.(Include area code) <br /> 55423 CCI Z) 666 - 3-2,6 7 <br /> �m o� <br /> Building Address _PA N /3 d/t y , W Subdivision Name Lot# Block# <br /> C5M V13 f 259 ,3 <br /> Legal Descriptiono Parcel No. <br /> 1/4, 1/4, Section O T 4-1 N, R S E or W <br /> 1. PROTECT TYKE , '2 C Ei(�VII'1► ]yT <br /> 19 1 Family V Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> I ENERGY SOURCE Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ E3 ❑ ❑ ❑ ❑ <br /> Water Heating ❑ fIY ❑ ❑ ❑ ❑ <br /> 4. CONSTRUCTION TYPE 5.FOUNDATION <br /> Site Constructed ❑ Concrete i7masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> sl <br /> 6.AREA 7. ESTIMATED BUILDING COST <br /> Living area= os b Square Feet 1 $ Sb/ U <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 /> Cha tersComm/ILHR 20-25,still,applies to all new 1-and 2-family dwellings and must be complied with. I understand that the <br /> su a of this perm't does ieu ne of ompliance with other applicable codes and ordinances. <br /> 4/r o O <br /> 7, <br /> A licant's Signature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> ISSUING JTJRISDICTI(?N; Town ❑ Village ❑ City ❑ County of: <br /> MUNICIPALITY-NUMBER: # 6� — � :3 FEES,of Dwelling Location <br /> PERMIT ISSUED BY: DATE <br /> n <br /> is- VE <br /> SBD-8254 (8.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />