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<br /> - t ra i x 'a "t. , n F s
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<br /> �: c' T Permit-
<br /> ` y . „5 Date:
<br /> �y'
<br /> �-.
<br /> ; •, ,BUILDING PERMIT APPLICATION
<br /> - _ ;
<br /> f MK 0 .?`2lown af,„Burke
<br /> f,-4.,:, _
<br /> Attention Town Clerk
<br /> ' " _ -,401fi_: East Washington :Avenue
<br /> Madison, Wisconsin-- . 53714
<br /> The undersigned hereby applies for a permit to build,,
<br /> construct, or remodel or install according to the following statement:
<br /> 1. T Locat ' n: No. Street
<br /> 2. Owne e.-)-2,;-,...19-1 "2,..,;,__ _t_.„ Address 3957? .r: 7,1/ '9
<br /> 3. Section .3 Lot Block Subdivision ,`%
<br /> 4. Type of Occupancy f- -
<br /> YP P Y �;:��y_ Type of Construction
<br /> 5. Size ., , feet wide_x • -3 , feet long cubic feet
<br /> General Contracto Work Consists of' (check)
<br /> A .. New Building Addition --~-
<br /> Address - Alterations , , Repairs
<br /> . Est. Cost Complete-Not over , ,j--c/c.,
<br /> Phone No. Fe�s. � .a=z..)
<br /> set of plans (Permit rats on file with Town of Burke)
<br /> Show Building Inspector
<br /> IT IS HEREBY AGREED between the undersigned as owner or hi agent and `
<br /> the Town of Burke that in consideration of the permit` to ,construct,
<br /> erect, alter or install as above-described, to be issued and-granted
<br /> 7. by the Town of Burke that all of said work will be done in accordance
<br /> with the description herein set forth in this statement, and as more
<br /> fully described in the specifications and plans herewith filed; and
<br /> the undersigned further agrees to construct, erect, alter or install
<br /> in strict compliance with the Ordinances of the Town of Burke, all
<br /> building codes adopted by the Town of Burke, and the State Building Code.
<br /> By Agent or Owner ---
<br /> Address
<br /> Phone No.
<br /> NOTE: TOWN OF BURKE HAS ADOPTED THE CITY OF MADISON BUILDING CODE
<br /> - 0 RTNF. TR PRRMTSRS nnnnPTRT] RFFOR 1 • 1, ••
<br /> •
<br /> NOTE „ uildingInspector Phone 241-3588 j-, -:-. -' .4. ''' - - -.:- - " -' -
<br /> , , __ .
<br /> r i.,.T �p the-_ --- �_; _ - N "
<br /> --.-# _ '_4_ Bier y_alley-Circle, _beForest, Wiseonsui �. S-34 ,. ` -
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<br /> � ` ; �= y --r*-"--"~ PP -Oa ,on�Approved = - e-7 ._;` , - ;
<br /> "r 1:
<br /> ` Town. Clerk of Burke
<br /> 4 .
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