Laserfiche WebLink
Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new 1- PERMIT APPLICATION Safety and Buildings <br /> .and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) Division <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> PERMIT APPLICANT' <br /> Last Name First Name Middle lnitial <br /> orLl`cKe- a 1,(2,e-h e , <br /> Street Address <br /> St, fi n n '-5 Cp h V� tt� 020 <br /> City State Zip Code Telephone No. (Include area code) <br /> SoMe. r5e- t Wi'sC , .5'41Da6' I--lis-.23FD <br /> PRp,IECT L+© i1CION <br /> Building Address /� y/ Subdivision Name Lot# Block# <br /> Ooh l e' '`Z'ctra- YCLY01 eh �dh'q Dr, 3 <br /> Legal Description3a3ls S y V7 1°�u s ` .�-'// -4 Parcel No. <br /> 1/4, /4, echon T N, R E or W <br /> .Jr. PROSECT TYPE .PROTECT HVAC E ITIPMEIYT <br /> 1 Family Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Famil 11:1 Boiler ❑ Central AC ❑ Other: <br /> 3' PRIEC'I'E>?1ERGY$+QURCE Nat. Gas L.P. OR Elect. Solid , Solar <br /> Space Heating ❑ ® ❑ ❑ ❑ ❑ <br /> Water Hea ' ❑ ® ❑ ❑ ❑ ❑ <br /> PROJECT CENSTRVCTIII!N'1'XPE 5 PRO,iECT FIII1NIl►ATION <br /> N Site Constructed D9 Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other ec' <br /> 6'rPROJECT ARE ESTIMATED PROJECT BUII,DIN G COST <br /> Living area= $ not C22242 e ted e— L W- <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. <br /> I understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm/II.HR 20-25,Still applies to all new 1-and 2-family dwellings and must be complied with I understand that the <br /> issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> A icant's Signature Date Si ed <br /> MUST BE COMPLETED BY THE MUNICIPALITY REFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> I%rVING JURISDICTION: Town ❑Village ❑ City ❑ County of: <br /> 1t1NI(:I +ALY NUMBERS # -7 - © �� F1gE5; _ <br /> Sifl�v�lioglaes6aa. <br /> PIliR.1VII'I'I+�Sll3E�BY. ; A <br /> it .ISSUED; <br /> � <br /> SBD-9254 (R 08/97) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />