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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING Stet of isc in n <br /> municipalities for new I- PERMIT APPLICATION Y <br /> ngs <br /> and 2- family dwellings (Wis. Stats. 101.63 (7)& 161.65 (3)) Division <br /> SEE INSTRUCTIONS ON BACK OF YELLOW[Privacy[ vacLaw 15.04(1)(m)] <br /> y <br /> personal information you provide may be used for secondary purposes. <br /> PERMIT Ai'PLICANT Middle Initial <br /> Last Name First ame <br /> Str Address ( <br /> � n <br /> cityStgt�y Zip� 1� T�ep�e No. Inc111d%� <br /> PRE)JJEC T IACATI©N <br /> Building Address Subdivision Name Lot# Ski# <br /> l ' <br /> Legal Description 7 T `t NR Par <br /> , 7 E or W $" <br /> 1/4, 1/4, Section <br /> 1: PROJECT TYPE .PROJECT HVAC EpMENT ❑ Heat Pump <br /> Forced Air Furnace ❑ Radiant Baseboard or Panel <br /> 1 Family ❑ Central AC ❑ Other' <br /> 2 Famil ❑ Boiler <br /> 3 PROJECT ENERG SOIRCT Nat. Gas L.P. Oil <br /> Elect. Solid Solar <br /> Space Heating 0 0 0 ❑ ❑ ❑ <br /> Water Hea ' _ ; <br /> I►g,(jC j�iSTRL1CTIN TYPE * IE'RO.TE+C"I F onry ❑ Treated Wood <br /> ❑ Site Constructed ❑ Concrete <br /> ❑ Manufactured ❑ Other � ; <br /> r. PR0IECT AREA ' �. ESTIMATEp PROTECT BUILDING COST <br /> area= S uate 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 /> lied with. I understand that the <br /> Chapters Comm/1LHR 20-25,still a lies to all new 1-and 2-family dwellings and must be comp <br /> issuance of permit oes not re me o pliance with other applicable codes and�or <br /> 6/ <br /> A 'cam's Signature <br /> Date Signed <br /> MUST BE COMPLETED BY THE <br /> MTTNI(IPAL FORE FORWARDING FINK PLY TO THE STATED SION OF SAFETY AND BUILDINGS <br /> Towne ❑ City 11County of: <br /> $SUING JURISDI01, <br /> SBD-8254 (It O&97) White-Issuing jurisdiction Pink-State Wit 30 Days Yellow-Applicant <br />