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•OF M.tO <br /> Town of Madison Application for Building Permit o I-Cy,,o <br /> 2120 Fish Hatchery Rd.Madison,WI 53713 a <br /> For Inspections Call(608)210-7217 ` r, <br /> S►. s <br /> Construction Erosion <br /> Owner's Name <br /> 00Vairn 6 Llln -fa . LLC <br /> /11/-1 •, go •• • I <br /> Address <br /> -TO a :ei S <br /> Phone Number <br /> 1-11. _ 4.n nSLO,( . 53�gz <br /> ntractor's Name n,, k <br /> • <br /> Address e <br /> L615 — $4 4 I S VQ.nashR uv T- 5 314 Z <br /> Phone Number <br /> OLd-- CV-0- —35b1D Loch_ G74.4,4- wc_t dov. 171c- 2_-o3c3 <br /> Project Address Parcel Number <br /> —11 r) 010(1-363-a3,45-a <br /> Project Type 10 New Alteration 7.1 Repair $n Raze to Move 0 Fence ! Other. <br /> Occupancy Type 0 Single Family i Multi-Family 0 Shed/Garage 0 Commercial <br /> Project Description: -- '.�.,. /1./1 .f t 0 el IOr' - g,• , ..f _._. 1.1 <br /> FT) • <br /> Estim41 Building Cost$ <br /> The applicant agrees to comply with all applicable codes,statutes and ordinances and with the conditions of this permit;understands that the issuance of the permit <br /> creates no legal liability,express or Implied,cope oepa and rifles thayll the above Information Is accurate <br /> Applicant Signature&Date: (o(2-10 117 <br /> Approval Conditions <br /> Fees: Permit . By: <br /> Plan Review j00 as V <br /> _Inspection q y ,13 Name <br /> Erosion y 0.0 Date • O(a 1 Z$ I .01 1 <br /> F' A...41 r N <br /> Total E14.)a,4,z 5 r , o"p Certification It q 5-3-7 77 <br /> 9 5e3.93 <br /> TR#' - Date r] 17j[ t u• '. • '' w 1 GFS# <br /> • <br />