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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin -# , 7 <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 SECOND FLY <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> Iva <br /> avow" '1111i <br /> Last Name u First Name Middle Initial <br /> Street Address <br /> y/6! Aub <br /> City State Zip Code Telephone No. (Include area code) <br /> MN SYI;n - 6'57 -687 - 00 Y3 <br /> `; <br /> Building Address Subdivision Name Lot# Block# <br /> S/1Y k'tSrMM ?�Q&) £SA4 3 P 6 y <br /> Legal Description Parcel No. <br /> 1/4, 1/4, Section T _2N, R -0 Af E offl <br /> ,'::� :., <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 ❑ x ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> aap <br /> ii <br /> Site Constructed ❑ Concrete Jx Masonry ❑ Treated Wood <br /> ❑ Manufactured(to the WI UDC,not U.S. HUD code) ❑ Other(s eclf ): <br /> �•. 'z a, D\OO�r�\' ��.frl' tir i\ ,r ..�.Y,a„ .'„, �: ,,, ,� .Mr��!� wi r�Uzi <br /> Living area= 2 Square Feet $ 60d- <br /> I vouch that all the above information is correct,and understand that the issuance of this permit is for administrative purposes only. I <br /> understand that onsite construction inspections will not be performed by the municipality,but that the Uniform Dwelling Code, <br /> Chapters Comm 20-25,still applies to all new I-and 2-family dwellings and must be complied with. I understand that the issuance of <br /> this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> A 1pant'aignature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY IREFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> Town ❑ Village ❑ City ❑ County of: �/ Lj <br /> MIA <br /> SBD-8254 (R.2/00) Distribution: 0 Ply 1-Issuing Jurisdiction 0 Ply 2-Municipality Forwards to State If New Dwelling 0 Ply 3-Applicant <br /> ISSUING JURISDICTION <br />