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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 maybe used by other government agency programs[Privacy Law,s. 15.04(1)(m)l <br /> :PEItMIT APPLICANT, <br /> Last Name First Name MiddleInitial <br /> Parkins Gary <br /> Street Address <br /> 1607 Little Butternut Lk. Ln. <br /> City State Zip Code Telephone No (include area code) <br /> Luck WI 54853 715-472-2602 <br /> PROAMOCAtION <br /> Building Address Subdivision Name Lot# Block # <br /> Lincoln STreet Jeffries Estates 5 2 <br /> Legal Description Parcel No — <br /> Section 3_T ___41L R JrW E OF W 20-9225-02-3 O <br /> tPROJECTTYIPIE 2.: PROJECT HVAC EQUIPMEN1 FamilyT <br /> Cg Forced Air Furnace El Radiant Baseboard or Panel (Elec.) E] Heat Pump <br /> E) 2 Family El Boiler 0 Central AC 0 Other: <br /> K:PROJECT ENERGY SOURCE Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 El El El 1:1 <br /> 77777777 <br /> Water Heating El El El ❑ El <br /> 4. PROJECT CONSTRUCTION TYPE, 5. PROIJ ECT FADUIN <br /> DAMON z <br /> Site Constructed Concrete ❑ Masonry E Treated Wood <br /> E] Manufactured 71E] Other(specify): <br /> 6. PROJECT AREA , <br /> 7. ESTIM0.TEDPROJECT.BUILDINGCOST <br /> Living area Square Feet $ d <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 ILHR20-25, still applies toall 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 /> ZAppI=icantC'Lignatdre <br /> DateSignecr <br /> 111111M <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> ISSUING JURISDICTION. EJ Town E] Village ❑ City EJ County of: Oakland <br /> Where Dwelling <br /> , MUNICIPALITY NUMBER: 0 7 - 0 2 0 Located FEES: I None <br /> PERMIT ISSUED BY: Burnett County Zoning DAT 6/3/96 <br /> SBDB 8254(13 09/94) white-issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br /> SIP <br />