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Call (262) 544-8280 or 1-800-422-5220 PERMIT NO. INDEPENDENT WI UNIFORM PERMIT APPLICATION PERMIT NO. INSPECTIONS,LTD. TAX KEY# ISSUING TOWN ❑VILLAGE ❑CRY PROJECT LOCATION MUNICIPALITY OF s`v^/ P2/4/i0/E (Building Address) CoT / / 52t•Ev//id /OD.- COUNTY: 7 AJ•E PROJECT DESCRIPTION A/� '4:?, -`T'p`--NG" .- ❑ COMMERCIAL ,If ONE&TWO FAMILY Owner's Name Mailing Address-Include City&Zip .$43,$27 Telephone - Include Area Code T - /167 TM-Ai 8t2t-7 W9 S9 t? r./-/ 7-7- &c:•777-44e aae,e/E ,4// Go 8-4.95-go4/41 Construction Contractor(DC Lic No.) 990 7/8 Mailing Address-Include City&Zip Telephone -Ind de Area Code 585 ls8 �oM¢ . n'GE Co v,72iael D/2S ,E-J767 .4)hiw4'Go �r•i2/ 1€ 1,24E�iJ w/S 6,08 .588-4Dr3 f Dwelling Contractor QualRer(DCQLicNo.} Dwelling Contractor Qualifier shall be an owner, Telephone Include Area Code 99a�/ CEO.COB,or employeeofDwellingContractor .4'en aE .SricE a3.v772,9e-v/2,5 -7 'E /,4 CrG 6,08/6-$8- 4/O3y PlumbingContractor(LicNo.) Z Zry/72.. Mailing Address-Include City&Zip 5 .sa8. Telephone-Include Area Code ,47,C,7-7--/w,# ),,,,,,,,./ /03GvM43i.1.J4 2 G q. N/,,-/e'x 1 . S-r .5,042•/4 42E J w/ 6a8-58e-7/$3 Electrical Contractor(Lic No.) z s/e,6-cz, Marling Address-Include City&Zip Tdephone -Include Area Coda /QV-440/Z yete-4sW E'4cc'72/c / 97 .8ev2cAi.c-.e4)r /2401. , -/re4/42347/24 w r 6'42S-7-2:1-3.9.5.---3. HVAC Contractor(Lic No.) 1,/633 Mailing Address-Include City&Zip Telephone-Include Area Code e ..72O/ti.t pfd/*C. 334./ C3.eocoie s. .D�2 Soo./PR2,Qe,B c.�/ 3359C) X008-837- 936.-7 PROJECT INFORMATION Subdivision Name Lot No. / Block No. Zoning District Lot Area N.S.E.W. Front Rear Left Right — 745./0_3 Sq.Ft. Setbacks lee Ft. 90/ Ft. .r O Ft. yl./. 6, Ft. 1a.PROJECT 3.TYPE 6.ELECTRICAL 9.HVACEQUIPMENT 12.ENERGY SOURCE ®New ['Addition❑Raze 0 Single Family Entrance Panel ® Forced Air Furnace Nat. LP. Oil Elec.Solid Solar ❑Alteration❑Repair ❑Move ❑Two Family Size: 2.00 amp ❑ Radiant Baseboard or Panel Fuel Gas ❑ Multi Service: ❑ Heat Pump Space Htg ® ❑ ❑ ❑ ❑ ❑ ['Other ❑Commercial 17 Underground ® Boiler ❑ Overhead ® Central Air Conditioning Water Htg ® ❑ ❑ ❑ ❑ ❑ 1 b.GARAGE 4.CONST.TYPE 7.FOUNDATION ❑ Other 'D Dwelling unit will have 3 kilowatt or more tt71 ❑Site Constructed I Concrete 10.PLUMBING installed electric space heater equipment Attached ['Detached Masonry capacity. 2.AREA LJMfd. HUD ❑Treated Wood Sewer 5.STORIES e ❑Municipal Other El Septic No. i' Z.D 1 L-tom W 13.HEAT LOSS(Calculated) Basement /SS/ Sq.Ft. 8.USE Living Area /SIT/ Sq.Ft. 02-Story ❑2-Story ❑Seasonal 11.WATER Total �J 3 671 fa BTU/MR Garage 979 Sq.Ft. ❑Other / Other Sq.Ft. la Per anent Municipal Utility 14.ESTIMATED COST TOTAL 908 el Private On-Site Well $ 3/6000 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. SIGNATURE OFAPPUCAN41!,, ,�./ ��4 Z/PRINT NAME .ns _.0.4-/e. /-/' DATE 6-z. -/C:, APPROVAL CONDITION f his 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 PERMIT PERMITISSUEDBYMUNICIPALAGENT: Zoning Fee Bldg. #At top of form EXPIRATION: WI Seal Zoning# CK# Permit expires Electric Fee Elec.# two years from Name Plumbing Fee Amount$ date issued HVAC Fee Plmb. # Date unless Date Adm. Fee municipal HVAC# From ordinance is Other more restrictive. Certification No. Total Rec By. White-Municipal Files Yellow - Applicant Pink-Clerk/Assessor Wisconsin uniform 03/11