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Permit #20756 <br /> Wisconsin Department of Industry, WISCONSIN ADMINISTRATIVE Safety and Buildings Division <br /> Lc1bor 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 may be used by other government agency programs(Privacy Law,s. 15.04(1)(m)]. <br /> PERMIT APPLICANT <br /> . .. :. <br /> Last Name First Name Middle Initial <br /> - IN IN r C- P, RO C- RT D, <br /> Street Address <br /> ?- 1432- 5 TN r <br /> City State Zip Code Telephone No.(include area code) <br /> I NVER<;ROVE CTS, itl �0 �G, /-/ e-- rI - g( 8 l <br /> P +fJECC'LUCAI ISN <br /> Building Address Subdivision Name Lot# Block # <br /> 639 '7 CIRCLE RD.PANRURY W-1. _S-q030 <br /> _ <br /> Legal Description ParcelNo. <br /> 1C�$v't Lot 1 a Section _2 T ___4D_N, R 16W E or w 20-4302-03-400 <br /> PROJECT TYRE 2. PROJECT MVAC E UTAMENT <br /> 1 Family 0 Forced Air Furnace ❑ Radiant Baseboard or Panel (Elec.) ❑ Heat Pump <br /> ❑ 2 Family ❑ Boiler ❑ Central AC W Other: Woo-r-) pkipfj_{Z <br /> B PENERGY S7URCE Nat.Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ U ❑ ❑ ❑ ❑ <br /> Water Heating ❑ ❑ ❑ ❑ ❑ <br /> PROJC f COII'STRUCTION TYPE . 5. PI[1JECT I~#�?UNOA TION <br /> Site Constructed ❑ Concrete Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6. PR' <br /> OJECTj AREA ?, ESTIMATEp P#tOIECT BIILI)INGiCOST <br /> Living area = Oc ZD Square Feet $ 80 000 9CJ 000 <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. I realize <br /> the issua ce of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> Applicant's Signature Date Signed <br /> MUST BE COMPLETED BEFORE SUBMITTING TO DILHR: <br /> IS VING'JURISDICTION: K] Town ❑ Village ❑ City F-1 County of: Oakland <br /> Where MUNICIPALITY NUMBER: 0 7 0 2 0 Located wellFEE None <br /> PERMIT IS5ULD BY: Burnett County Zoning DATE ISSIJI Qt. 8/18/97 <br /> S8DB 8254(R 09/94) White-Issuing Jurisdiction Pink-DILHR Within 30 Days Yellow-Applicant <br />