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INSTRUCTIONS <br /> he own-, t_,uilder or =yen > ;l <umplete and provide all required in formation on the application <br /> form down through the Sgn;t,re -,f Applicant hlock ".G data is used for statewide statistical <br /> gathering on new one- and two-family dwellings, as well as for local administration. Whim <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, lot 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 /> 1_ Type - Check only "11 Family" or "2-Family" if that is what Is being buil_ In other words, <br /> do NOT use this form If only a new detached garage is being built, even 'f it serves a one <br /> or two family dwelling <br /> If project is a commonity based residential faciFty servsng 3 io 8 resir.'enL, it is considered <br /> a single-family dwelling. <br /> 2. HVAC Equipment - Check only the major source of heat, not any supplemental sources. <br /> Mark central air conditioning if present Only therk "Radiant Baseboard or Panel" if <br /> there is no central source of heat. <br /> 6- Living Area- include any finished area including finished areas in basements. <br /> For two-family dwellings, 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 /> Checkoff MUMCIPALITY STATUS, such as town,village, city or county <br /> Fill in MUNiCIPAI ITY NUMBER Gr D'Jv-LING I OCATION ;sued by a county, indicate <br /> the Specificr,-.1_riLipalltynumber-Vdhere tFie dwa_Ihng Alli be burit <br /> ,.. , • narr.c° of L u.�^ ,. : I,e�r, r ,c! date' 1')�r,9 nr rm�.t issued <br /> iiL YUR4t PtNN t:OPY WIThiIN 30 DAYS AFTER ISSUAtiCE TO: <br /> DILHR- Safety&Buildings Division. <br /> P.O. Box 7969 <br /> Madison,WI 53707 <br />