Town of Shelby - La Crosse County Wisconsin

Town of Shelby Application for Building, Plumbing, Heating and Electrical Permits

2800 Ward Avenue
La Crosse, Wisconsin 54601
Phone: (608) 788-1032
Fax: (608) 788-6840

Zoning Permit Number _________

Shelby Permit Number _________

Parcel number _________

Date

Address of Construction or Installation

Property Owner's Name

The undersigned hereby applies for the following permit:

Purpose Cost of Project Cost of Permit
Building
Electrical
Plumbing
Heating
Other
  Total

Architect or Designer

General Contractor Name

Contractor Phone Number

Carpenter Name

Mason Name

Plumbing Contractor Name

Heating Contractor Name

Electrical Contractor Name

IT IS HEREBY AGREED between the undersigned as owner, his agent or servant, and the Town of Shelby, that for and in consideration of the premises and of the permit to construct, erect, alter or install as avobe described, to be issued and granted by the Inspection Department, that the work theron will be done in accordance with the description herein set forth in this statement; and it is further agreed to construct, erect, alter or install in strict compliance with all zoning and building laws of the Town of Shelby and the State of Wisconsin; and to ober any and all lawful orders of the Inspection Department made or issued by virtue of the provisions of said ordinances. As a further condition of this permit, the undersigned owner, or his agent, hereby consents to entry on the premises described hereon, byt the Inspection Department, at all reasonable hours, for the purpose of inspection. It is further agreed that 48 hours notice, (excluding Saturday and Sunday), must be given to said Inspection Department prior to Inspection or granted of permit. Such notice shall be given at the office, of the Town Clerk, Town Hall, 2800 Ward Ave, 788-1032. Monday through Friday 8-4.

Contractor or Owner Name

Address

Signed

Phone Number

Application Approved Date ______________

Inspector Signature _______________________________
Inspector's Phone Number: 608-780-4672

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