Laserfiche WebLink
Submit to non-enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin <br /> municipalities for new I- 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 YELLOW COPY. <br /> Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] <br /> PERMIT APPLICANT <br /> Last Name First Name Middle Initial <br /> Street Address <br /> 9 a `��J� P � eco© os 1_ 12 <br /> City State Zip Code TT7Zo—ITephoneo. (Include area code) <br /> e c's I�, `rya - <br /> PROJECT LOCATION <br /> Building Address Subdivision Name Lot# Block# <br /> 641 Ci k i D R o 4/ <br /> Legal Description Parcel No. 6 36 63-636 <br /> 1/4, 1/4, Section T _!90_N, R TO E or(D —44 CSM V I GP <br /> 1. PROJECT TYPE 2. HVAC EQUIPMENT <br /> 1 Family ❑ Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump <br /> ❑ 2 Family Boiler ❑ Central AC ❑ Other: <br /> 3.ENERGY SOURCE Nat. Gas L.P. Oil Elect. Solid Solar <br /> Space Heating ❑ 2k ❑ ❑ ❑ ❑ <br /> Water Heating ❑ 101_ ❑ ❑ ❑ ❑ <br /> 4. CONSTRUCTION TYPE 5. FOUNDATION <br /> Site Constructed WConcrete ❑ Masonry ❑ Treated Wood <br /> ❑ Manufactured ❑ Other(specify): <br /> 6.AREA 7. ESTIMATED BUILDING COST <br /> Living area= Square Feet $ ccu <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 /> Chapters Comm/ILHR 20-25,still applies to all new I-and 2-family dwellings and must be complied with. I understand that the <br /> iissttanpe of this permit does not relieve me of compliance with other applicable codes and ordinances. <br /> ( � 7—/z-- l `�' <br /> Applicant's i nature Date Signed <br /> MUST BE COMPLETED BY THE MUNICIPALITY BEFORE FORWARDING PINK PLY TO THE STATE DIVISION OF SAFETY AND BUILDINGS <br /> ISSUING JURISDICTION: Town ❑Village ❑ City ❑ County of: U&t <br /> MUNICIPALITY NUMBER: # Z_ - O 3 FEES: <br /> of Dwelling Location <br /> PERMIT ISSUED BY: y DATE <br /> ISSUED: <br /> CRD-8254 (R.2/981 White-Issuing Jurisdiction Pink-State Within 30 Days Yellow-Applicant <br />