Laserfiche WebLink
Wisconsin DEpartinent 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. See instructions on back of yellow copy. <br /> ........... <br /> M iw <br /> R. ITr <br /> .................... <br /> Last Name First Name Middle Initial <br /> ' /So ty Iz <br /> Street Address <br /> g <br /> City State Zip Code Telephone No.(include area code) <br /> R <br /> ........... <br /> X* <br /> P .0#CTCA Ilm <br /> Building Address Subdivision Name Lot# Block <br /> A�-- C e IL'llvo'e- "2'0- 1 <br /> Legal Description Parcel No. <br /> 1/4, 7/4, Section T N, R Ll <br /> NT <br /> 1 Family LJ Forced Air Furnace ❑ Radiant Baseboard or Panel(Elec.) E] Heat Pump <br /> F-1 2 Family Boiler ❑ Central AC ❑ Other: <br /> IRO jEC <br /> Nat-Gas L.P. oil <br /> Elect. Solid Solar <br /> Space Heating Cl ,K ❑ 0 1:1 El <br /> Water Heating El ❑ El ❑ El <br /> 4.' :P 0 i Ef <br /> CON$TRUSTI fllt TYPE 5. PROJECT <br /> .I"t?UNI7ATIOAI <br /> Site Constructed E] Concrete Nr Masonry C] Treated Wood <br /> 0 Manufactured F1 Other: <br /> 8. PROJECT <br /> T <br /> E. AREA A .7 <br /> IMATEO ago L 6 <br /> 'C ST, <br /> I IDIN <br /> Living area = p Square Feet 0 eo <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. Irealize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> ApplicJnt' ignbture Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> :ISSUING <br /> S1XCTIONr:L'::ZL'r.L: own rN__1 <br /> Village Q City of: Llot>oam <br /> MUN1CIt►kI,ITYMIUMBERR <br /> # 0 <br /> Pf RMffL ISSUE!)BY, <br /> Zof)i no 1 x0eJ6— I <br /> J <br /> SBD 8254 IN 09/89) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />