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Permit #15887 <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 I-and 2-family dwellings. See instructions on back of yellow copy. <br /> .... .... .. ...... <br /> RM C It,W-W %K. <br /> �o <br /> y <br /> Last Name First Name Middle initial <br /> VOLGREN JOHN ET AL <br /> Street Address <br /> P.O. Box 188 <br /> City state Zip Code Telephone No.(include area code) <br /> Balsam Lake WI 54810 715-485-3194 <br /> K <br /> ...... .. . <br /> Building Address Subdivision Name Lot# Block# <br /> Bass Lake Road <br /> Legal Description Parcel No. <br /> G.L. 1 1/4, 1/4, Section 13 T 41 N, R 16W E or W 32-5313-01-100 <br /> �K <br /> C.1-QUIPMENTx:i <br /> xx <br /> M-1—Fa-mi-i Fy E] Forced Air Furnace lekadi nt Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family E] Boiler 0 Central AC 0 Other: <br /> EEKERG:Y�.� il Elect. Solid Solar <br /> crNat.Gas L.P.L.P. <br /> Space Heating 11 11 El 0 Ll <br /> Water Heating El 11 El El <br /> k­PR .... ....................... <br /> .............. <br /> Site Constructed ❑ Concrete ❑ Masonry Treated Woo <br /> ❑ Manufactured jj::Other: <br /> :P AR A 7 ISTIMAT. <br /> Livinq area = Square Feet $ <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. Ireafize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> 2 <br /> Appl,c*'sSignOTMe Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ING Town Q Village ❑ City of: <br /> 0 3 2 None <br /> UTY N kv 0 7 <br /> # <br /> SU Zoning Ofice 9/23/91 <br /> PERMIT IS ED W_ <br /> SBD 8254 IN 09/89) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />