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,; �S:�Z7 <br /> Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new I- PERMIT APPLICATION Safety and Buildings <br /> and 2-family dwellings Vis. Stats. 101.63 (7)& 161.65 (3)) Division <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 /> TERMIT APPLICANT'. <br /> Last Name First Name Middle Initial <br /> `-� <br /> Street Address <br /> City State Zip Code Telephone No. (Include area code) <br /> f Skfo a l �7 -c��? - 3440 <br /> 1PRO�'EG'T LOBATION <br /> Building Address �, EP-tc w + Subdivision Name Lot# Block# <br /> s <br /> Legal Description Parcel No. <br /> 1/4, LiE 1/4, Section 146 T �L-7 N, R Lim E o <br /> 1.« PROTECT TYIRE 4.]PROSECT TIVAC E TTIPMENT <br /> 1 FamilyForced Air Furnace ElRadiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ <br /> thiBoiler ElCentral AC El Other: <br /> FR�j, i E {GQj} Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ El El 11 11ElWater Hea ' ❑ ❑ ❑ ❑ <br /> 4 PROTECT GINSTRi1CTIN T'I'PS « PROJECT FOUNDATION <br /> 191 cite Cg c�t-• -4 ,�Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured- ❑ Other <br /> 6...PRU,1ECx ASA 7 ESTIMATEA PROSECT BUIfLi?IIYG COST <br /> i.I _area= Square Feet $ <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 /> is a of s permit does not relieve me of compliance with other applicable codes and ordinances. <br /> A ant's Si a Date S ed <br /> MUST BE MPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE D ION OF SAFETY AND BUILDINGS <br /> dURISDICTIO1�Ts Town ❑Village ❑City ❑ County of <br /> 8101 AL 11 N 1SER: <br /> of 7tHagiaa�ion .. <br /> ERMa 'a0U B : -7-79 <br /> C (L✓ /1 ISSUIED <br /> SBD-8254 (R 08/97) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />