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,-�) -7/6 <br /> 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 SECOND FLY <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> Last Name First Name Middle Initial <br /> / tit <br /> Street Address/� r <br /> s cu CCS W �,G�vl o <br /> City State Zip Code Telephone No. (Include area code) <br /> Building Address Subdivision Name Lot# Block# <br /> Legal Description Parcel No. <br /> 1/4, 1/4, Section T N, R E or W <br /> J2V 1 Family jK Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler Central AC ❑ Other: <br /> ,,;, •" °' Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ ❑ ❑ ❑ ❑ ❑ <br /> Water Heatin& ❑ ❑ ❑ J29 ❑ ❑ <br /> N, 05`1`1a <br /> Site Constructed ❑ Concrete ,Z Masonry ❑ Treated Wood <br /> ❑ Manufactured to the WI UDC; not U.S.HUD code) ❑ Other(s ecif ): <br /> 0111M�,l 'WR <br /> Living area Square Feet $ 4 OD0 <br /> I vouch that all the above information is correct,and understand that the issuance ofthis permit is oi41 o I I <br /> understand that onsite construction inspections will not be performed by the municipality,but thatjthe Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I UUZZ <br /> un6taid tabid a�issua e�of <br /> this permit does not relieve me of compliance with other applicable codes and ordinances. LL <br /> _,� /c;,2- _5--WXNETT COUNTY <br /> Applicant's Signature Date Signed ZONING <br /> MUST BE COMPLETED BY THE MUNJCIPALI BEFORE FORWARDING PLY 2 TO THE STATE DIVISIQN OF SAFETY AND BUILDINGS <br /> Town ❑ Village ❑ City ❑ County of. <br /> SBD-8254 (R.2/00) Distribution: ❑Ply 1-Issuing Jurisdiction ❑Ply 2-Municipality ornards to State If New Dwelling ❑Ply 3-Applicant <br /> ISSUING JURISDICTION <br />