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Permit #18404 <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 1-and 2-family dwellings. <br /> SEE INSTRUCTIONS ON BACK OF YELLOW COPY. <br /> La Name F- st Name Middle Initial <br /> G' <br /> Street Address <br /> City State Zip Code Telephone No.(include area code) <br /> t)/9U P,X syr830 HOY-Y <br /> . ............. <br /> ! <br /> X <br /> "A)CIT, <br /> 11. ......... .... .. ........ <br /> 0.- <br /> Building Address Subdivision Name Lo:# Block # <br /> Black Bear Acres 9 <br /> Legal Description No. <br /> 1/4, 1/4, Section 36 T 41 N R 17W E or W Parcel <br /> 32-9050-01-900 <br /> ..... ................. <br /> ....:,::; q: ........... <br /> .. ENT. <br /> ........ <br /> M 1 Family Forced Air Furnace 0 Radiant Baseboard or Panel(Elec.) ❑ Heat Pump <br /> ❑ 2 Family E] Boiler 0 Central AC ❑ Other: <br /> 09 N Mr., 3UIt Nat-Gas L.P. Oil Elect. Solid Solar <br /> Space Heating 0 0 <br /> Water Heating El 13 0 El <br /> ............. <br /> PROaE <br /> q <br /> .. .... R .0 <br /> ........ <br /> CA Site Constructed E] Concrete CK Masonry F] Treated Wood <br /> E] Manufactured _F1 Other: <br /> .......... <br /> AREA; . 1 <br /> M <br /> ESTIMATEDRECTB <br /> X T <br /> xgl <br /> Li vi nci area = lo 7.;7, Square Feet s 71 iil"00, 4'0 /4 fox, <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. Irealize <br /> the issuance of this permit does not relieve me of compliance with other applicable codes and ordinances- <br /> A,� <br /> Applicant's Signature DatWSigned <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> .......... <br /> :ISSUING JU1tI:S6IcTIbNi,..,­,,".0 )t3 Town El Village 0 City El County of: Sv iss <br /> Where <br /> FMUNICIPAW E n 7 . 0 3 2 LocatedDwelling NonE <br /> Zoning Office DATE ISSUED.: <br /> 4/20/95 <br /> SB D-82 54(R. 02/90) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yell w-Applicant <br />