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INSTRUCTIONS <br /> The owner, r,uUcer or agents shall complete and provide all required .formation on the application <br /> fo,m dOJN'n thro, ,F ihe 1ign4l,,rr£' of Af pl ':ant bloik This dal.a is Used for Statewide SiatistlCal <br /> gotheriny on neiv orae- and .No family dwellings, as Nell as for local administration. When <br /> completed, submit to local municipality having jurisdiction. <br /> PERMIT REQUESTED: <br /> • Fill in building address. <br /> • Fill in legal description of lot, subdivision name, tot number and block number <br /> PROJECT DATA: <br /> • Fill in all numbered project data blocks (1-7) with the required information. ALL DATA <br /> BLOCKS MUST BE FILLED IN, INCLUDING THE FOLLOWING: <br /> Type - Crary curly n.,�+, • cr " 2 Family" if trail :< vhel is be ng :,u i' crlher words, <br /> or two family dwelling <br /> ^d <br /> a single-family dwelling <br /> 2_ HVAC Equ;pment ' Check only the major source of heat, not any supp'emental sources. <br /> Mar' cer n+l air :nnditinning if present. Only check "Rad:ant Baseboard or Panel" ` <br /> There is no central source of heat <br /> 6 livingArea-iridoide any finished area indUding finished area;!n basements. <br /> For two-family dwell,ngs, include total combined areas. <br /> 7. Estimated Cost- Include the total cost of construction, but not cost of land or landscaping. <br /> SIGNATURE: <br /> • Sign and date application form. <br /> ISSUING JURISDICTION: <br /> • This must be completed by the AUTHORITY HAVING JURISDICTION <br /> Check off MUNICIPAI I?'/STATUS, such as town,village, city or county <br /> Fill in A/IUNirIPAI.ITY NUMBER OF D'./v'Eil_ING '_OCATION It isSUed bye county, indicate <br /> r •,przfir n,r•�c;p ' ty r umber wYiere ti� dwelllny v li hr• butt <br /> it rraat �`pe'sr� iinq perrno and dale h�,olding permit ,5,r.ied <br /> RETURN PINK COPT WITHIN 30 DAYS AFTER ISSUANCE:TCS. <br /> DILHR-Safety&Buildings Division <br /> P.O. Box 7969 <br /> Madison,WI 53707 <br />