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#20467 <br /> Wisconsin Department of Industry, 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 /> The information you provide may be used by other government agency programs[Privacy Law,s. 15.04(1)(m)]. <br /> PERMff APPLICANT <br /> : <br /> Last Name First Name Middle Initial <br /> sl2th ek~ me-1 0; 1 d_ � 4 ra l L <br /> Street Address <br /> Cit State Zip Code Telephone No (include area code) <br /> �e� <br /> PROX. C'I'lO AI N <br /> Building Address Subdivision Name Lot# Block # <br /> �Ghrc�[QcJ LQ h� ` <br /> LegalDescription Parcel No. / <br /> s E_1/4, _)1/4, Section _3 7 T 37 N, R �_ E or 002-1636-03-510 <br /> 9. 'PRfJJCf TYRE . PR0IECT HVAC IQUIRMiRNT <br /> 1p <br /> 1 Family ❑ Forced Air Furnace Dq Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> � i PRO.[ CT ENERGYSfiURCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> j PROJECT CONSTRUCTION..:!* E 5 P�t1pJ'E+CT I"OUNOATION <br /> Site Constructed ❑ Concrete ❑ Masonry O(Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6. PR0IECT AREA G�11 7. ES f1MATED AR0iECT BUILDING COST <br /> Living area = pC 5 uare Feet $ o 61(, <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 not 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 1-and 2-family dwellings and must be complied with. I realize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> ": 6 - 13 -9z <br /> pp 'cantsSignature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION: [ Town ❑ Village ❑ City ❑ County of: Anderson <br /> Where Dwelling <br /> MUNICIPALITY NUMBER: # <br /> __a__ __2 Located FEES: None <br /> PERMIT ISSUED BY: Burnett County Zoning Office DATE ISSUED: 6/11/97 <br /> SBDB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />