Laserfiche WebLink
Submit to non-enforcing WISCONSIN ADNIINISTRATIVE 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 SECOND FLY <br /> Personal information you provide may be used for secondary purposes. (Privacy Law 15.04(1)(m)] <br /> t �ro h xa E <br /> ,dmk �' 71111 <br /> Last Name /Name Middle Initial <br /> Street Address <br /> City State Zip Code Telephone No. (Include area code) <br /> �s71 711 <br /> a.�'e,.? r n •.r�,;rEo ,,[° r d r,:$^, rr "w.-' <br /> 3 SAT'^ <br /> Building Address Subdivision Name Lot# Block# <br /> Legal Description 1Parcel o. <br /> 1/4, E or W <br /> 1/4, Section R� I' - , <br /> '`3"•�F •a. ,.. ., ,`, ^,'"..�., � : s¢ , ,,,, w b syr iota�r�r� S��. <br /> -1 Family orced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Famil ❑ Boiler ❑ Central AC ❑ Other: <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ Nff- ❑ ❑ <br /> Water Heatin ❑ ❑ ❑ ❑ ❑ <br /> In <br /> 'IZ=Slte Constructed -Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured(to the WI UDC,not U.S.HUD code) ❑ Other(s eclf ) <br /> <� ..., �,.. '', v r��a•r�: r)<„Y;ci },° ass l��'' �,� tin sa �,:s,.,.� n t m i� <br /> S <br /> H <br /> Living area Square Feet $ 600 00 <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. I <br /> understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I understand that the issuance of <br /> this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> A13,31ict's Si ature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALI BEFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> Town ❑ Village ❑ City ❑ County of: <br /> # <br /> Mutt <br /> SBD-8254 (R.2100) Distribution: ony 1-Issuing Jurisdiction ❑Ply 2-Municipality Forw s to State If New Dwelling ❑Ply 3-Applicant <br /> ISSUING JURISDICTION <br />