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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 /> Last Name First Name Middle Initial <br /> !�o r� /ter Grp T3 <br /> Street Address <br /> City State Zip Code Telephone No. (Include area code) <br /> SOP" rr^s e- i <br /> INK© ) LO T ,b4 , Al ." <br /> � `" c � � d,e,;.,:, ,�.+wwva,+,• ,raww weu^.bm_... W. «.,m:.,.,q..,.a«4 swe p.kM ,n`d;�... =..,.a— + .^N- '«w:a.�wwp;v' ,,°t a <br /> Building Address Subdivision Name Lot# Block# <br /> �3Gs� (�,stiu...; �k� /rte: / G s,�, ✓, < a2 <br /> e, a 73 <br /> Legal Description �/ Parcel No. <br /> 1/4, 1/4, Section / �T 3b N, R /� EorW <br /> .7` t � 9nY�; ds. <br /> 1 ]� ;TV <br /> OL 1 Family Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler Central AC ❑ Other: <br /> 311NU'R irY Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ 39- ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> 4 CQNSTRUC'la.oNTYPE S FOUNDATION <br /> cEQSite Constructed ❑ Concrete Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> °b.AREA 7 ESTIMATED BUILT?jN COST <br /> Living area= 7 6,:;?— Square Feet $ 5 pop <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 /> issuance of this permit does of relieve me of compliance with other applicable codes and ordinances. <br /> `�^ c //- 26—oo <br /> Appli is Signature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETIV AND BUILDINGS <br /> ISSUING C Town ❑ Village ❑ City ❑ County of: <br /> ., . . <br /> MUNICIPALITY NU1 'BER:of DwellingLocation <br /> DACE 3 .( <br /> PERMIT ISSUED BY• <br /> SBD-8254 (R.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />