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• I Call (262) 544-8280 or i — 8 �� INDEPENDENT WI UNIFORM PERMIT APPLICATION ION PERMIT NO. , INSPECTIONS, LTD. Tu12/V ON $OS L3EA/ 22 TAX KEY# f ISSUING TOWN ❑VILLAGE ❑CITY PROJECT LOCATION Nor EXAcr /11DLY2FSs (Building Address) �� FIq)e rl� (Z��r MUNICIPALITY of�u2 t'l�Ai�/ - - NQ PF2»1 AOARc'SS ��J � �r COUNTY' A like PROJECT DESCRIPTION ��IJ/�i Sc eIii c e Ownefs ms in COMMERCIAL pry & TWO FAMILY Mailing Address'•Include City&Zip ��—�5Z g Telephone - Include Area Code t31s B Env /�« rniy/ML, _s-7—, Ct O S pI.4,,vS 4.08- p733--- ZS YS C c ontractor (Lk No.) Mailing Address-Include City&Zip /C,S C/1/ AL L�C �S y Telephone- include Area Code Plumbing Contractor (Uc No.) Mailing Address Include�r&Zip S �2 ��ry/�%r 60 — 8ZS— rySs Telephone - Include Area Code Electrical Contractor (Uc No.) Mailing Address•Include City&Zip ITelephone - Include Area Code HVAC Contractor (Llc No.) Mailing Address-Include City&Zip Telephone-Include Area Code 1/4, 1/4, SECTION ,T N,R I PROJECT INFORMATION Subdivision Name E(or)W Lot No. Block No. j Zoning District 1 Lot Area N.S.E.W. Front Rear Left Right Sq. Ft. Setbacks Ft. Ft. Ft. Ft. 1 a. PROJECT 3. TYPE 6. ELECTRICAL 9. HVAC EQUIPMENT 12. ENERGY SOURCE 0ANew ['Addition['Raze 0 Single Family Entrance Panel iteration❑Repair ❑Move ❑ Two Family Size: pmp ❑ Radian Air Baseboard Fuel Nat. L.P. Oil Elec.Solid sour I ❑ Multi Service: ❑ Radiant Baseboard or Panel Gas ❑Other ❑Commercial ❑ Underground ❑ Heat Pump Space Htg El ❑ ❑ ❑ ❑ ❑ Overhead ❑ Boiler t aer Htg ❑ ❑ ❑ ❑ Central Air Conditioning ❑ ❑ ❑ lb. GARAGE 4. CONST. TYPE 7. FOUNDATION ❑ Other •0 Dwelling unit will have 3 kilt or more Installed electric space eater ❑Attached ❑Detached ['Site Constructed ❑Concrete 10. PLUMBING ep: R 2. �� ['Manufactured ❑Masonry Sewer equip. Infiltration control option is: ❑Full ❑Treated Wood sealing of air Infiltration Blower door test. 5. STORIES ❑ Other 0 Septic ❑ Exterior air Inillfratlon barrier. Basement Sq. Ft. ❑Permit No. 13. HEAT LOSS (Calculated) • Living Area Sq. ❑ 1-Story 8. USE q. Ft. ❑2-Story 11. WATER Garage Sq. Ft. ❑Other ❑Seasonal Total Other ❑Permanent BTU/HR Sq. Ft. ❑Other ❑Municipal Utility 14. ESTIMATED COST rOTAL ❑Private On-Site Well the applicant agrees to comply,with the Municipal Ordinances and with the conditions of this permit; understands that the Issuance of the permit treated no legal liability, express or implied, of the Department, Municipality, Agency or Inspector; and certifies that all the above information is Jccurate.Have Permit/Application number and address when requesting Inspections. Call(262)544-8280 or 1-800-422-5220. Give at least 24 i lours notice on all inspections. L 2/2 i�SIGNATURE OF APPLICANT aJ DATE /D-3/—O P APPROVAL CONDITIONS T Is 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. - c 41_4. FD/2 //v5/ c270-c. /—BCv0- y, _ Sa ac t - 'X' RE/19/. INSPECTIONS NEEDED ❑ Footing El Foundation ❑Rough ❑ Insulation ❑Basement Floor Final FEES: PERMIT(S) ISSUED SEAL NO. I Municipality No. - _ _ wilding Fee PERMIT 'oning Fee Bldg. #At top of form RECEIPT EXPIRATION: PERMIT ISSUED BY MUNICIPAL AGENT: VI Seal Zoning# lectrlc Fee CK# C',qS// Permit D 670P - lumbing Fee Elec.# Date��-� d 8 two years from Name r /_ C' date Issued IVAC Fee Plmb.# ' From AL unless Date /0 — 3/- 06 dm. Fee HVAC # municipal )ther D1�c ordinance is ��TO u otal 'yO Rec By. �f� more restrictive. Certification No. White-Municipal Files Yellow-Applicant s onseuntom tips Pink - Clerk/Assessor '