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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 /> The information you provide may be used by other government agency programs[Privacy Law,s. 15.04(1)(m)I. <br /> PERMIT APPLICANT <br /> Last Name FLrst Name Middle Initial <br /> r LUQ V_ Wil/ /9-/Y\ /( . <br /> Street Ac@riss <br /> alb Al )0a_y 7`_o A , <br /> City State Zip Code Telephone No.(include area code) <br /> r�r► , soa � 1a a� <br /> P IJECT 111 AI'ON <br /> Building Address Subdivision Name LOt� Block#::. <br /> ! l5(lp 6a Im e L t.c s <br /> Legal Description Gov't Lot 4 Parcel No. <br /> 1/4, 1/4, Section 27 T 37 N, R JRW E or W <br /> 9 <PRO1£ 'f TYPE 2. PRfl�EET HVAC EQUIPMENT.; <br /> 1 Family orced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> 3 PR0JECT ENERGY SOURCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ <br /> 4 PRIvl1ECTC©NSTRUC 'IEfI�tTy 1E. S. PRLIJE+CTI~t?UN[3AfI0N <br /> Site Constructed Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6 PROJECT AREA ?: ESTIMATED PRCfJECT BU1, DING COST <br /> ��11 JI v� <br /> Livingarea = v� b Square Feet $ `t <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. I realize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> 6 tVhL' <br /> pplicant'sSi at a 155VSignetf <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION. Town ❑ Village ❑ City ❑ County of: Trade Lake <br /> Where Dwelling <br /> MUNICIPALITY NUMBER: # 0 7 0 3 4Located SEES: None <br /> PERMIT ISSUED BY: Burnett County Zoning DATE ISSUED: 7/8/96 <br /> SBDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />