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f#20433 <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)I. <br /> VERMIR APPLICANT <br /> .: <br /> Last Name First Name Middle Initial <br /> SNCL2/ J?-/' ES L <br /> Street Address <br /> City State Zip Code Telephone No.(include area code) <br /> eV/mow /7 ��/2 6 �/2- ��Z - 7�rYf` <br /> 1 R0JfCt LOCA110NX. <br /> Building Address Subdivision Name Lot# Block# <br /> ,%,Iz 1�6�1 7e12 p� S7 W� Oakland Shores 9 <br /> Lega Description Parcel No. <br /> 1/4, S 1/4, Section 16 T 40 N, R 16W E or W 20-9325-02-500 <br /> !. PRQ CT .PE 2; PROACT HVAC EEjt#IPIA NT <br /> 1 Family ® Forced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC ❑ Other: <br /> 3. PROJECT ENERGYSOURCE :i Nat.Gas L.P. Oil Elect. Solid Solar <br /> _ .. <br /> Space Heating ❑ ® ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ ❑ <br /> 4. PRQJECTCONSTRl1CTICENITYPIr 5. PIt1ClJIwCT QUNDAT'IQN <br /> ®'Site Constructed (KConcrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured 0 Other(specify): <br /> 6..PROJECTAREA 7. ESTIMATEDPRtJIECTfiWI.DINGGOST ........ <br /> Living area = 3 © Square Feet $ '/ O <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 /> LJ <br /> pplicant's Signature to Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTIOW ® Town ❑ Village ❑ City ❑ County of: Oakland <br /> Where <br /> MUNICIPALITY NUMBER: # 0 7 0 2 0 Located <br /> welling FEES. <br /> None <br /> PERMIT ISSUED BY: Burnett County Zoning Office DATE 195015.6 A.1 6/5/97 <br /> S8D8 6254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />