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brarliflabonsin
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<br /> ,- partmentof Industry, WISCONSIN UNIFORM
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<br /> .tlitiOr&Human Relations
<br /> , -Divisibn of Safety&Buildings • BUILDING PERMIT APPL CATION NO.
<br /> v:.Box 7969-
<br /> Madison,WI 53707 APPLICATION N. 09°S7 73 18'9_5o 7
<br /> Wisconsin Statutes 101.63,101.73 , Moe Instructions on back of pink py) PARCEL NO.
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<br /> TERIMMEO •
<br /> ti UCTION 1---- HVA‘Gc„,. E ELEC El PLUMBING El OTHER:
<br /> Owne ', ‘ame • Mai i • '•• .:,-. ; - Telephone
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<br /> Alri...o.e.
<br /> A. .... A.....alet.arial- ' 0.■. fa.d 1.. I I II i".'Alb/ 1:-•', ■••I I I/ A■••I I 4.1.4 -
<br /> Con actor's Name i J P Mailing •ddr:•:..
<br /> t f m ■■•,, :lephone
<br /> A 1
<br /> . 1. 3 -4417
<br /> I 411111.. Ai / ,-__.- /....... ...; ....11 .... AllW.4-..-.1.....I11.-••■-•afA' t
<br /> Lot Area /
<br /> \;: :...: ....°.'.'I .. ..;::!: i`a ::';L'''Jt e NM
<br /> :::::::::i:i:iiiiiiiiiiiiiiiniiiiii:iiiii::i:iiaiiiiiMi::::•imi::::.x.x....:...........:.....____ Sq.ft-.
<br /> % 14 SECTIO T • N R E or W
<br /> Buil4ing Address A / Subdivision Name Lot No. Block No.
<br /> .11.,
<br /> Zo g District(s) Zclin9 Permit l'i, Front I Rear Left Right
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<br /> ....... /.......6.-- ..-:-... Sebadcs -ft I ft ft. ft.
<br /> ....... . 34.. :p .nc1
<br /> IIMELECTRICAL:::::::ili:::ISVACEQUIPMENIM:::::::::::•::::::::42ZENERGISOURCE:::::::::::ii:::::::2:::::::::
<br /> lagew 0 Repair 0 Single.Family Entrance Panel 0 Forced Air Furnace Fuel IN L.P. Oil Elec.SolidSolar
<br /> 0 Alteration 0 Raze bi:kliamily Size: amp 0 Radiant Baseboard or Panel Gas
<br /> 0 Addition 0 Move ge Service: 0 Heat Pump Space 11tg. 0 0 0 0. 0 0
<br /> _ 0 Other 0 Underground 0 Boiler Water l-1 .I 0 0 0 0 0 .0
<br /> • .0 Overhead 0 Central Air Conditioning
<br /> 0 Other 4:440SSIVIIPE*gir 9UNDATION:Ti' 0 Other *0 Dweiling unit will have 3 kilowatt'or
<br /> more installed electric space heating equip.
<br /> , 'Mite constructed Ioncrete 1O PLUMBING Infiltration control option is:0 Full sealing
<br /> ZAREAMOINEICCE::::::::::::::::::::::::::::::: 0 Manufactured 0,.., Masonry ...... of joints. 0 Blower door test. 0 Exterior
<br /> L.J Treated Wood beweunicipal air infiltration barrier.
<br /> •• 0 Other Septic :43"Itteifittit ittiiiiiiiiiiiii:iiiiit,
<br /> Unfinished Basement sq.ft.i:IL:4170RIES:::::::::::
<br /> :;:i,i,i,i4i Permit No.
<br /> 0 1 BTU/HR
<br /> Living Area &I'ft' -Story Bpaional it WATER Infiltration BTU/HR
<br /> Garage/9 o—r) sq.ft.
<br /> - Other 0 Other L1 eunicipal Utility
<br /> Private on-site Well - ICataillatiO................100-.......Win
<br /> 0 Plus basement . $ ,/et-OP or) .
<br /> The applicant agrees to comply With all applicable codes,statut:- and ordinances and withathe conditions of this permit understands that the issuance of the
<br /> permit creates no legal liability,express or implied,on the'.pa .:nt or Munici•silty;and certifies that all the above information is accurate.
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<br /> SIGNATURE OF APPLICANT ............ . ''S' •
<br /> --- • ' DATE
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<br /> CONDITIONS OF APPROVAL This permit is issued pursuant to the following conditions.,Failure to comply may result in suspension or
<br /> revocation of this permit or other penalty. ;7
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<br /> Municipality Number of Dwelling
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<br /> ISSUING' :'•.....,::::.l .-'.•• 11---
<br /> OWN (1] ,v11_, . i IN,CITY 0 COUNTY Municipality Number of
<br /> ' 0 STA7 Eli.NrE 1046 T
<br /> , , I nsp,ctiR Authority _ Location,if different
<br /> JURISDICTION /7 -z/ ,-.7
<br /> OF: /,_ _e,--_.1 .,-. -,';'...e"- ...____ „
<br /> PE.RMIT(S) WS-UNIFORM PER mrn - -
<br /> FEES: r ?tRMIT IsSUF.D BY ----% i
<br /> 1\ 'SUED :SEAL NO. i j ,
<br /> is, ,., k I ,/' „ 7- . , 7 •
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