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Permit 618631 <br /> Wisconsin Department of Indus", WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Labor and Human Relations BUILDING PERMIT APPLICATION <br /> (Wis.Stats. 101.63(7)& 101.65(3)) <br /> Submit to non-enforcing municipalities for new 1-and 2-family dwellings. <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> . .......... .. <br /> Last Name First Name Middle Initial <br /> Stre4tXddres <br /> Ale, -if Sd <br /> City State Zip Code Telephone No.(include area code) <br /> ... ....... <br /> ............................ <br /> V. <br /> Building Address Subdivision Name Lot# Block# <br /> '3 /3e),C4 41i I <br /> -Legal Description PAcel No. 9001 <br /> NW 1/4, SW 1/4, Sectic�5 3q T 39 N, R i14W_' E or W 3130,�03NAI/00c)" <br /> . ....... <br /> 7] 1 Family L] Forced Air Furnace L] Radiant Baseboard or Panel (Elec.) 0 Heat Pump <br /> n 2 Family C] Boiler 0 Central AC E] Other: <br /> Nat <br /> 3 Gas L.P. Oil Elect. Solid Solar <br /> PROJECT IS <br /> 11E, ERG, <br /> Space Heating 0 <br /> Water Heating El 0 11 0 <br /> �x <br /> p <br /> 4 <br /> Site Constructed El Concrete C] Masonry ❑ Treated Wood <br /> E] Manufactured [0 Other: <br /> ............ . ..... .... ... ...... <br /> ?RGOT <br /> Eq <br /> . ..4eQA <br /> ne <br /> ....... N <br /> PRO1E .I. REA <br /> Livincl area = Scluare F $ �0/7 e, <br /> I present that all the above information is correct, and understand that the issuance of this permit is for <br /> administrative purposes only. Onsite construction inspections will not and shall no) be performed by the <br /> municipality which has not assumed jurisdiction per s. 101.65, Wis. Stats. I understand the Uniform Dwelling <br /> Code,Chapters ILHR 20-25,still applies to all new l-and 2-family dwellings and must be Complied with. Irealize <br /> the i ante of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> Applicant's Signattlyt DatL.Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> Md: E] Town E] Village ❑ City C] County of: <br /> Rusk <br /> Where Dwelling <br /> I, ��K None <br /> Mu:i4:[CIOA.t,J,TY.NU..M$E,Ftw�.,,# 0 7 0 2 4 Located <br /> PERMIT.15SUf By14Zoning Office 6/13/95 <br /> SBD-8254(R. 02/90) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />