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INSTRUCTIONS <br /> The owner, builder or agents shall complete and provide all required <br /> information on the application form down through the Signature of Applicant <br /> block. This data is used for statewide statistical gathering on new one- and <br /> two-family dwellings, as well as for local administration. When completed, <br /> submit to local municipality having jurisdiction. <br /> PERMIT REQUESTED: <br /> - Fill in building address. <br /> - Fill in legal description of lot, subdivision name, lot number and block <br /> number. <br /> PROJECT DATA: <br /> Fill in all numbered project data blocks ( 1-7) with the required <br /> information. ALL DATA BLOCKS MUST BE FILLED IN, INCLUDING THE FOLLOWING: <br /> 1. Type - Check only "1-Family" or "2-Family" if that is what is being <br /> built. In other words, do NOT use this form if only a new detached <br /> garage is being built , even if it serves a one or two family <br /> dwelling. <br /> If project is a community based residential facility serving 3 to 8 <br /> residents, it is considered a single-family dwelling. <br /> 2. HVAC Equipment - Check only the major source of heat, not any <br /> supplemental sources. Mark central air conditioning if present . <br /> Only check "Radiant Baseboard or Panel" if there is no central <br /> source of heat. <br /> 6. Living Area - include any finished area including finished areas in <br /> basements. <br /> For two-family dwellings, include total combined areas. <br /> 7. Estimated Cost - Include the total cost of construction, but not <br /> 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 MUNICIPALITY STATUS, such as town, village or city. <br /> Fill in MUNICIPALITY NUMBER OF DWELLING LOCATION. <br /> Fill in name of person issuing permit and date building permit <br /> issued. <br /> RETURN PINK COPY WITHIN 30 DAYS AFTER ISSUANCE TO: <br /> DILHR - Safety & Buildings Division <br /> P.O. Box 7969 <br /> Madison, WI 53707 <br />