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<br /> t.., r ' Permit^_,.-o� e- ,_' 6 may- - _ _
<br /> 3 Date: �/ y„-,v,.. �,
<br /> -� ,. :` BUILDING: PERMIT APPLICATION
<br /> o-
<br /> TO 4": Town of Burks
<br />` , -Attention.'. Towri Clerk - _ {
<br /> f-` =- 4016 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. Locatio : No. Street -
<br /> 2. Ownerl�-, - 079 . Address 5, 4 /f
<br /> 3. Section ot_ Block Subdivision
<br /> 4 . Type of Occupancy f - Type of Construction
<br /> 5. Size /6: feet widx .,1< feet long cubic f t 11
<br /> •
<br /> Work Consists of (check) -
<br /> General ntracto 0w Ld '_, ..mew Building Addition
<br /> Address 4d1_0-- Alterations Repairs
<br /> - Est. 'C2s ,,Complete-Not over Go-zv-,)
<br /> Phone No. Fees "/0"a
<br /> set of plans (Permit rates on file with Town of Burke•)
<br /> Show Building Inspector e Z , Nc,,
<br /> IT IS HEREBY AGREED between the undersigned as owner or his 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 /> 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 1, . _
<br /> in strict compliance with the Ordinances of the Town of Burke , all____.---,-t - ------"----;--
<br /> building codes adopted by the Town of Burke , and the State Building Code . -
<br /> By- . . - -g ( . ,`'�-'4--r ------ Agent or Owner
<br /> Address {( . ! _,,, 1,y I^,: _ t'~ = �' „ __.„-. ? / 'f
<br /> Phone No.
<br /> NOTE: TOWN OF BURKE HAS ADOPTED THE CITY OF MADISON BUILDING CODE
<br /> s50 FIND. IP PREMISES flCC'TPTEZ) REF DR R FINAL
<br /> -NOTE: _:Buildiing,-Inspector Phone 241-3588 - - ` .. - •
<br /> t Lathe _- -
<br /> >� �=625A,:.$DmmO.r Valiey�Circ�.e.,= Deforest,_ Wisconsin . 53.5,-3 2 ,
<br /> „ .=* - _ _ -T. ._ _ -
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<br /> if 7## � s��" � . � j � rr ,g t r .� 3 ` ; �1 7lic�-tior Ap; 9%-
<br /> f ,./ ,, _ ��._� 7 .� � J�a e t. /�-
<br /> . e' -
<br /> - - Town .Clerk of Burke .
<br />
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