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B./SC-I.J-;.( I6€"V/+$7 l:;?A{ ZONE (2-1 6 STREET NO. d cJ C S- ~~,- /~.-J LOT D I MENS IONS 7s- 'j'/ / _? SIDEWALK EXISTING YES D NO ~ BUILDING GRADE ELEVATIONS STAKES SET AT SITE , 19 BY FEE: $2.00 ~C ~~~~ DEPARTMENT OF PUBLIC WORKS ~,8 . I, the undersigned, owner or agent of the above described property agree to have the grade established befor~~;/avation has comm~~ ~ 29~' ) 11 OWNER ..1;;;}.{ . ~S0P OA~t:I2t~#PERtlIT #l~,?-)_C\ GENERAL CONTRACTOR J2~ ( 13- MASON. CONTRACTOR ZONE . DATE --1'.2 :?i- 00 0 INSPECTIONS l!!!:.~4.-?4~. ... ... . APil9nl@~~-~ C '/ .-~ ~. 29 i9J ~&7"'~~ AODRESS~!) H4HJ{ ~.u USE Pi2-- S't--: J dr ( 4 J--- t~J , -t MAn.J:NG ADDRESS Entrance ,Pan;!., Size: 10 k: ~ice rJ Underground o Overhead 6. CONST. TYPE 7. FOUNDATION o Seasonal Id1Sermanent 0 Private O Il."unicipal Other ..J..-"'lVI The applicant agrees to comply with the Wisconsin uniform~Welling 9"d other Municipal Ordinances and with the conditions of this permit; understands that the issuance of the permit creates no legal liability . express or' plied~ ~the Department or Municipality; and certifies that all the above information IS accurate. A A~ / SIGNATURE OF APPLICANT 7frA. fi A/~//A DATE .3 -/s-~d-5 STATE OF WISCONSIN DE'ARTMENT OFINDUSTFIY. LABOR AND HUMAN RELATIONS DIVISION.OF SAFTV AND BUILDINGS 201 E. WASHINGTON AVE. BOX 7919 MADISON, WI. 63707 WISCONSIN STATUES 101.83, PERMIT REQUESTED ~ Name /J / tJ/o-l I~'c I+- COntractor's Name OW~t1-- PROJECT LOCATION B.uilding Address ~ I ,;l4.-~::;- I-fA/'4/ (JV)./ ~ Zoning District Lot Area ;Z-1~7.$- 'fll]~ 2. TYPE 1. PROJECT ~w o Alteration o Garage o Attached o Detached o Other o Master plan no. (if applicable) OAddition 0Single family o Two family o Other DSite const. ~anufactured 9. AREA (Outside \ Dimension J 10. STORIES lLl13asement 100 g sq.ft. c;}f.Story / ft'J 0 ,,4 02-Story t.JL ~ sq.ft. OOther c:;;h::iving Area o Garage sq.ft. WISCONSIN UNIFORM BUILDING PERMIT APPLlCA TION ~ONST ~VAC Mailing Address ;L 7~ 0 CUt5.57;t4L'!Pft-, Mailing Address PERMIT NO. h g3cJ l:s-=- PARCEL NO. j&ELEC !J ./"0/1-:.0 o PLUMB Telephone ;)-"3/- 9 ~3 Telephone , T N, R E(or)W LOjt'? BIOC~ Left /. Right "7 ~ ft. ....2.~/..l... ft. 5. ENERGY SOURCES Y.. Y.., SECTION SUI~di . ion Na~e I fil/. . ~ ;/ eN- c '-4 e..t/,p~ , I Front .IRear / . S f Setbacks '-J (- tR 4- q. t. ~ -:; ft. ft. 3. ELECTRICAL 4. HVAC EQUIPMENT [2l{;oncrete o Masonry o Treated Wood o Other 11. USE 0Forced Air Furnace Fuel Space Water AMP o Radiant Baseboard or Panel Htg. Htg. o Heat pump LP Gas 0 0 o Boiler Nat. Gas fl 0""" o Central Air Condo Fuel Oil 0 0 o Other Elec. 0 0 Wood 0 0 8. PLUMBI NG Solar 0 0 Sewer Coal 0 0 .0M'unicipal Other o Septic o Permit No. 12. WATER CONDITIONS OF APPROVAL This pe~mit is is~ued pu~~ant to the following conditions. Failure to comply mSlY result in suspension or revocation of this permit or other penalty. \ 13. ISSUING JURISDICTION ()5 tW?tJ~# NAME FEES PERMIT(S) ISSU.ED 0'CONST. .e1'HVAC JdELEC o PLUMB PLAN REVIEW $ INSPECTION WIS. PERMIT SEAL(S) OTHER ( .I TOT A L $ ? ,..J '30 ~C~ DILHR-SBD-5823 OVILLAGE ."'!:fCITY DSTATE o TOWN o COUNTY MUN IC. NO. :2 d- 7& ~ WIS. UNIFORM PERMIT SEA! NO.(S) L ?9'y 9" '/~4-/9 I ~4/Y . PERMIT ISSUED BY , ..... NAME U. J': VOl P rfJ-A.~ DATE /3"~ /...(.1- ~ %3 CERTNO. :3S;'-- z-/o~ ISSUING JURISDICTION/AGENCY ::r: J> (.I) z --I I-i tulS m 0 rh z --I " .. ...... ,.,:. . '.., .',,, '" 'W;f~ '.'. .." .... ' . .... ..' .........,.::.;.. :'. .' ...,':.' :.'..'..... '" '" ..',c. '. '" ' ;' '; , '. ,..' ;,< "'" ...., ' . "~i' ~. _h__'"'__~_~/, . . STRJ. 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