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Call (262) 544-8280 or <br /> 1-800422-5220 PERMIT NO. <br /> INDEPENDENT WI UNIFORM PERMIT APPLICATION <br /> INSPECTIONS,LTD. <br /> TAXKEY# <br /> TOWN ❑VILLAGE El CITY PROJECT LOCATION (j <br /> ISSUING (Budding Address) I 7 )C o I i '1 kd T <br /> MUNICIPALITY OF , 1 i n `i� i n e • <br /> COUNTY: 0f) ., PROJECT DESCRIPTION Fe t i,s}"-Ct l f 'll• <br /> ❑ COMMERCIAL ❑ ONE&TWO FAMILY <br /> Owner's Name Mailing Address-Include City&Zip Telephone-Include Area Code _,,, <br /> t,At f, �I _1 . ni- 4 f�,.i t' .L f i r ..>r I n t d.. / Lash i t k)I 3% <br /> Constryduon Contractor(DCLiciNo'.) Mailing Address-Include 300&Zip Telephone - Include Area Code <br /> Dwelling Contractor Oualier(ma LicNo.) Dwelling Contractor Ouaiidersha$beanowner, Telephone-Include Area Code <br /> CEO,COS.orempioyeeorOwrdangContractor <br /> Plumbing Contractor(tic No.) Mailing Address-Include City&Zip Telephone-include Area Code <br /> Electrical Contractor(Lic No.) Mailing Address-Include City&Zip Telephone-Include Area Code <br /> 1-IVAC Contractor(Lic No.) Mailing Address-Include City&Zip Telephone -Include Area Code <br /> PROJECT INFORMATION Subdivision Name Lot No. Block No. <br /> Zoning District Lot Area N.S.E.W. Front Rear Left Right <br /> So.Ft. Setbacks Ft. Ft. Ft. Ft. <br /> la.PROJECT 3.TYPE 6.ELECTRICAL 9.HVAC EQUIPMENT 12.ENERGY SOURCE <br /> le New ['Addition❑Raze a Single Family Entrance Panel ❑ Forced Air Furnace Fuel Nat. LP. Oil Elec.Sobd Solar <br /> 1CIAlteration0Repair ❑Move Two Family Size: €+mP ❑ Radiant Baseboard or Panel Gas <br /> ❑Multi Service: ❑ Heat Pump Space Htg ❑ ❑ ❑ 0 ❑ ❑ <br /> Other t t-1 t. ❑Commercial 0 Underground nd ❑ Boiler <br /> ❑ Central Air Conditioning Water Mg © ❑ ❑ ❑ ❑ ❑ <br /> 1 b.GARAGE 4.CONST.TYPE 7.FOUNDATION ❑ Other •0 Dwelling unit will have 3 kdowatt or more <br /> Concrete installed electric space heater equipment <br /> ❑Site Constructed ❑ 10.PLUMBING capacity. <br /> ❑Attached ❑Detached Mfd. UDC ❑Masonry Sewer <br /> 2.AREA BMfd.HUD ❑Treated Wood <br /> ❑Municipal <br /> 5.STORIES 8 Other 0 Septic No. 13.HEAT LOSS(Calculated) <br /> Basement Sq.Ft. ❑1-Story 8.USE <br /> Living Area Sq.Ft. ❑2-Story 11.WATER Total BTU/MR <br /> Garage Sq.Ft. 0 Other 0 Seasonal <br /> Other Sq.Ft. <br /> 0 Permanent ❑Municipal Utility 14.ESTIMATED COST <br /> 0 Other ❑Private On-Site Well y <br /> TOTAL _$ (-p1 Q©Q•Ott <br /> The applicant agrees to comply with the Municipal Ordinances and with the conditions of this permit; understands that the issuance of the permit <br /> created no legal liability, express or implied, of the Department, Municipality, Agency or Inspector; and certifies that all the above information is <br /> accurate.Have Permit/Application number and address when requesting inspections.Call(262)5444280 or 1400-422-5220.Give at least 24 <br /> hours notice on all inspections. f f <br /> SIGNATURE OFAPPLICANT Al . et I t__ _ PRINT NAME Poe � me ATE. 812-VI t f� <br /> This per r is issued pursuant to the attached conditions. Failu tos comply may result in suspension or <br /> APPROVAL CONDITIONS revocation of this permit or other penalty. Owner/13uiider solely responsible for compliance with all <br /> applicable State & Local Building and Zoning codes. <br /> INSPECTIONS NEEDED Building ❑Footing ❑Foundation ❑Rough ❑Insulation ❑Bsmt. Fl. ❑Final <br /> Electric ❑Rough ❑Service 0 Final Plumbing ❑Rough ❑Underfloor ❑ Final HVAC 0 Rough ❑Final <br /> I PERMIT(S)ISSUED SEALNO. Municipality No. -.� ---- <br /> Building Fee RECEIPT PERMITISSUEDBYMUMCIPALAGENT: <br /> Zoning Fee Bldg. #At top of form EXPIRATION: <br /> WI Seal Zoning# CK#_ Permit expires <br /> Electric Fee Elec.# two years from Nam e <br /> Plumbing Fee Amount$ date issued <br /> HVAC Fee Plmb.# Date unless Date <br /> municipal <br /> Adm. Fee <br /> HVAC# From ordinance is <br /> Other more restrictive. Certification No. <br /> Total Rec By. . <br /> White-Municipal Files Yellow- Applicant Pink-Cierk/Assessor <br /> WlsconS.e Uniform 0311 r <br />