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Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new l- 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 /> Last Name First N-ame Middle Initial <br /> /,S,/7 (J <br /> Street Address <br /> C�1 _ N <br /> City State Zip Code Telephone No. (Include area code) <br /> 7-0,J-tj,4 <br /> WON" <br /> Building Address Subdivision Name Lot# Block# <br /> ed <br /> -Le n Parcel No. 6 -3 - .;to <br /> on (41 N, R E rrw) 1W <br /> 1 Family Forced Air Furnace 0 Radiant Baseboard or Panel 0 Heat Pump <br /> 0 Central AC 0 Other: <br /> Oil Elect. Solid Solar <br /> Space Heating ❑ g 0 0 0 0 <br /> 0 0 0 <br /> Site Constructed Concrete ❑ Masonry Treated Wood <br /> 0 Manufactured(to the WI UDC; not U.S.HUD code) 0 Other(s ecify): <br /> M" <br /> Living area= 7 Square Feet $ 6rc) <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 re me-qf compliance with other applicable codes and ordmances./ <br /> lic s Signature Date ed <br /> MUST BE COMPLE THE MUNICIpALrry ByFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> Town ❑ Village 0 City 0 County of: <br /> SBD-8254 (R.2/00) Distribution:oPly I-issuing Jurisdiction OPly 2-Municipality Forwards to State If New Dwelling 0 Ply 3-Applicant <br /> ISSUING JURISDICTION <br />