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;-aLis6/0 <br /> 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 YELLOW COPY. <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> Last Name First Name Middle Initial <br /> Al g 0, 42-GE .T" <br /> Street Address <br /> ,5z ) Z S/Z- 12- � X <br /> City State Zip Code Telephone No. (Include area code) <br /> ST �+/7llbw ll�l S' j Z- )8? — 3l <br /> Yl <br /> Building Address ?_ 9 _,S77_3 lzDN4- , KIA54ti Subdivision Name Lot# Block# <br /> 041L1,)gA16 4— #1j9yI16c -2�K1 i I <br /> Legal DesQription Parcel No. <br /> �/LU 1/4, -5 1/4, Section T N, R 1 E or& <br /> 77 <br /> .�• O ,T �L9 ,,.% �} «�. y..}'a:..# E+'r:E: R3-` 'S '^4 RsY?'.a .�n4 .`d"E°,ad.® €g <br /> 1 Family Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler 'Central AC ❑ Other: <br /> Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ )41 ❑ ❑ ❑ ❑ <br /> Water Heating ❑ 3!� ❑ ❑ ❑ ❑ <br /> 4i CON_sTRVC'1<'IO1 T`I E 5 " ?C#UNDATiON <br /> `l Site Constructed Concrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> b AREA 7: ETLIIATEIj BUI:DING`COST <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. <br /> I understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm/ILHR 20-25,still applies to all new 1-and 2-family dwellings and must be complied with. I understand that the <br /> issuancA of this permit d�otreel`iev me of compliance with other applicable codes and ordinances. <br /> /7 <br /> pplicant's gna ure Date Signed <br /> MUST BE COMPLETED BY THE MUNICI ALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> ISSUING JU�RIS IOIy Town ❑ Village ❑ City ❑ County of: <br /> MUNICIPALITY"NUM$ER: # - C) <br /> ofbwelling Location <br /> PERMIT ISSUED BY: <br /> SBD-8254 (8.2/98) White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />