Laserfiche WebLink
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 PLY <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> 0 <br /> ME <br /> m & <br /> La ,Name first N Middle Initial <br /> 16 <br /> Street Ad ess <br /> e �o <br /> City State Zip Code Telephone No. (Include area code) <br /> fi) WO G- r)IS-L-259-111191 <br /> Building Address Subd' on Name Lot# Block# <br /> Legal Description �// Parcel No <br /> 1/4, 1/4, Section T R E or My-* 2�z -'0 3 <br /> w <br /> I <br /> M NS,W111 ,111WIN <br /> MANOWN,WE me <br /> I Family Forced Air Furnace 0 Radiant Baseboard or Panel 0 Heat Pump <br /> 132 Fa 1 0 Boiler 0 Central AC 0 Other: <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 0 0 0 0 <br /> Water Heatin 0 0 0 0 0 <br /> 0 Treated Wood <br /> 0 Manufactured(to the WI UDC; not U.S.HUD code) 3 <br /> W WT, W_' <br /> 5K.4"M <br /> Living area Square Feet// $ <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. I <br /> understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all I-and 2-family dwellings and must be complied with. I understand that the issuance of <br /> this permit does not relieve me of co� ane!with other applicable codes and ordinances. <br /> - 9-67 <br /> Date Signed <br /> COMPLETEDMUST BY THE MIJNICIPAL1BEFORE FORWARDING PLY 2 TO THE STATE DIVISIRN OF SAFETY AND BUILDINGS <br /> Town 0 Village 0 City 0 County of: <br /> SBD-8254 (R.2/00) Distribution:0 Ply I-Issuing Jurisdiction OPly2-Municip Forwards to State If New Dwelling OPly3-Applicant <br /> ISSUING JURISDICTION <br />