Laserfiche WebLink
Wiscon;in Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labor and Human Relations <br /> BUILDING PERMIT APPLICATION <br /> (Wis. Starts. 101.63(7)& 101.65(3)) <br /> Submit to non-enforcing municipalities for new 1-and 2-family dwellings. <br /> SEEINSTRUCTIONS 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)l. <br /> P <br /> "T ,APPLICANT <br /> MEW <br /> Last Name First Name Middle Initial <br /> 4Q C, <br /> Street Address <br /> _ro <br /> City State Zip Code Telephone No.(include area code) <br /> PRQJECT OR <br /> .......... <br /> Building Address Subdivision Name Lot# Block # <br /> ej_- ( -3 <br /> 7 5 ) <br /> L 86 r <br /> gal Description <br /> NE 1/4 W 114 Section 36 T 41 Parte No <br /> _N, R 17W Por W 32-5436-01-900 <br /> 9. PROJECT TYPE9::: 2 PR JECT <br /> :D 9 HVAC EQUIPM <br /> 9 ENT_o�: <br /> 1 Family R Forc ed Air Furnace E] Radiant Baseboard or Panel (Flet.) 9 LJ Heat Pump <br /> El 2 Family M Boiler M Central AC 0 Other: <br /> 3.1:PROJECT ENERGY SOURCE] Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating El El El El El <br /> Water Heating <br /> 777777777777�= El ❑ El <br /> TYPE T <br /> 4-. PROJECT CONSTRUCTION S. PROJECT-FOUNDAT11ON <br /> YP" <br /> ® Site Constructed 7 Concrete Masonry— ❑ Treated Wood <br /> 0 Manufactured E] Other(specify): <br /> 6. IROJECTAREA :: 7 <br /> :z �i�' ESTIMATED PROJECT BU1LlDINdCoS <br /> T <br /> Living area = F 2- Squarefeet A) Af i <br /> I present that all the above information is correct, ano underStd,A that the issuance of this permit is for <br /> administrative purposes only. Onsite construction insp-:tions viii not and shall not be performed by the <br /> municipality which has not assumed jurisdiction per s. 101.65, Wis. Starts. 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. Irealize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> L I <br /> Applicant s Signature DateSigned <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION- [D Town El Village 0 City ❑ County of: Swiss <br /> Wher <br /> MUNICIPALITY NUMBER: # o 7 - 0 3 2 LocatedDwellin FEE - None <br /> PERMIT ISSUED BY: Burnett County Zoning DATE ll"IJEM 8/12/96 <br /> 5BL)B 8254(809/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant AFT% <br />