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Call (262) 544-8280 or 1-800-422-5220 INDEPENDENT WI UNIFORM PERMIT APPLICATION PERMIT NO. . INSPECTIONS,LTD. TAX KEY# p ISSUING 'TOWN f❑VILLAGE 12 CITY PROJECT LOCATION 7 Rd, (Building Address) '. }X 3"3,5-4_/, `MUNICIPALITY OF 511 /N,/ COUNTY: per, PROJECT DESCRIPTION P.c 1. IraC , 2i COMMERCIAL b ONE&TWO ILY Owner's Name Mailin Addre s-include Ci &Zi Telephone - Include Area Code D as t,tu .f 1r� ta44 724 3 RL;>& R mc� ei 1.01 c3S"6 A be,-J-35=1 273' Constr ctionContracto(0 ict�o Mailing Address'Include City&Zip f Telephone - Include Area Code G�,eov+. u� God.4439 7 P,D.$ox93o220V.,�aena,AJt,r.3S eit=4760 Dwelling Contract Qualifier(DCQLicNo.) Dwelling Contractor Qualifier shall be an owner, Teephone - Include Area Code CEO,COB,or employee of Dwelling Contractor Plumbing Contractor(L o.) Mailing Address- Include City&Zip Telephone - Include Area Code IVA Electrical Contractor(Lic No.) Mailing Address-Include City&Zip Telephone - Include Area Code AM- HVACContractor(LicNo.) Mailing Address-Include City&Zip Telephone - Include Area Code Alk PROJECT INFORMATION Subdivision Name Lot No. Block No. Zoning District Lot Area N.S.E.W. Front Rear Left Right Sq.Ft. Setbacks Ft. Ft. Ft. Ft. 1a.PROJECT 3.TYPE 6.STORIES 9.HVAC EQUIPMENT 12.ENERGYSOURCE New ❑Addition['Raze I:3 Single Family 02 1-Story ❑ Forced Air Furnace Fuel Nat. L.P. Oil Elec.Solid Solar lteration❑Repair ['Move ❑Two Fami ❑ Radiant Baseboard or Panel Gas ��yy ❑2-Story / El Multi (/{ ❑Other ❑ Heat Pump Space Htg ❑ ❑ ❑ ❑ ❑ ❑ ❑Other N T- ❑ Corn Comrhe ffc((al ❑ Boiler Htg ❑ ❑ ❑ ❑ ❑ ❑ 4.CONST.TYPE ❑ Central Air Conditioning Water Ht 1 b. GARAGE 7.FOUNDATION ❑ Other Ai It. 'D Dwelling unit will have 3 kilowatt or more ['Site Constructed ❑Mfd. UDC El 10.PLUMBING installed electric space heater equipment ['Attached ['Detached ❑Mfd. HUD ❑Masonry capacity. A�T d 2.AREA 5.ELECTRICAL El Treated Wood Sewer ❑CF ❑Municipal _ Entrance Panel ❑Other 0 Septic No. 13.HEAT LOSS(Calculated) Basement Sq.Ft. Size:—amp 8.USE Living Area S Ft. Service:_Nev�Rewire � i 11.WATER Total /M BTU R Garage �� Sq.Ft. —F Volts ❑Seasonal _Underground ❑Permanent ❑ unicipal Utility 14.ESTIMATEDCOST Other Sq.Ft. Overhead ❑Othew t. rivate On-Site Well TOTAL Power Company: N $ gg/cB P�6'0 The applicant agrees to comply with the Municipal Ordinances and with the conditions of this permit; understands that the issuance of the permit created no legal liability, express or implied, of the Department, Municipality, Agency or Inspector; and certifies that all the above information is accurate. Have Permit/Application number and address when requesting inspections. Call (262) 544-8280 or 1-800-422-5220.Give at least 24 hours notice on all inspections. 1 / *' /cX)t1? SIGNATUREOFAPPLICANT '�" 4t4' PRINT NAME l�gd,,.e flat(en 1 041 DATE APPROVAL CONDITIONS This permit is issued pursuant to the attached conditions. Failure to comply may result in suspension or revocation of this permit or other penalty. Owner/Builder solely responsible for compliance with all applicable State & Local Building and Zoning codes. INSPECTIONS NEEDED Building ❑Footing ❑Foundation ❑Rough ❑Insulation ❑Bsmt. Fl. ❑Final Electric ❑ Rough ❑Service ❑ Final Plumbing ❑ Rough ❑Underfloor ❑ Final HVAC ❑Rough ❑Final FEES PERMIT(S)ISSUED SEAL NO. Municipality No. -- - — -- Building Fee RECEIPT PERMff PERMIT ISSUED BY MUNICIPALAGENT: Zoning Fee Bldg. # At top of form EXPIRATION: WI Seal Zoning # CK# �omears expires from Name Electric Fee Elec.# y Plumbing Fee Amount$ date issued HVAC Fee Plmb. # Date unless Date municipal Adm. Fee HVAC# From ordinance is Other restrictive. Certification No. Total Rec By. White-Municipal Files Yellow - Applicant Pink-Clerk/Assessor Wisconsin Uniform 02/14