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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)J <br /> DIY v' N F d <br /> Last Name First Name Middle I *tial <br /> Street Address <br /> X7 0 S Oo Lk- �- <br /> City State Zip Code bl <br /> lephone No.(Include area code) <br /> � l w1 5Q1�(3 9-k --7 / 5 9 <br /> 7777777777777 <br /> e-01 <br /> , <br /> Building Address Subdivision Name Lot# Block# <br /> &jK3� ,706�byi LL 1111__� <br /> Legal Descriptionff__ Parcel No.I / <br /> 1/4, �� 1/4, Section T O N, R �P E o w dp� `�30 Dz 6 oU <br /> 73'`R°s° fws�v}�;1uk -+ :! <br /> 02"] Family ❑ Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family Boiler flYCentral AC ❑ Other: <br /> .ElE1GT" 1 „C �° �1ti�,�.� � Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ W_ ❑ ❑ ❑ ❑ <br /> Water Heating ❑ SK ❑ ❑ ❑ ❑ <br /> #.:CONSTRUCT,©N TYPE . 5.FOUNDATION <br /> KrSite Constructed IPConcrete iiMasonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> b.AREA 7..I ESTIMATED:UmbI G COST <br /> Living area= o2oZ J0 Square Feet $ 3�0 <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 not relieve me of compliance with other applicable codes and ordinances. <br /> Applicant's Signature Date Stgned <br /> MUST BE COMPLETED BY THE MUNICIPALIT BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> IUIN{s JLT Town ❑ Village ❑ City ❑ County of: <br /> MUNICIPALITY NUMBER: <br /> of Dwelling Location <br /> PERMIT'ISSUED BY: 00 <br /> SBD-8254 (R.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />