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WLlJOU::~ C/) e: C) US ca c..> 'C - c..> ~ LU a: eo 0= <co a: I- z 00 o C/) CJ ell z<D i= <C 0) W ::l :I:LL C/) Os <x: tii Q) C) I ,!; '"0 e: .' 0) ~E~]1 '"0 0) E 13 6~:Cca 00000 DATE s-- Z 7- (j 3 NAME ])AJt () 'j;( 641ZL LOT!~:>- SUBDI v. /~e-jj /~/ltT STREET NO. ~fL7t? $" t:)C3-5'CH t- ADDRESS {J-~ BLOCK WARD ZONE /2 ~/6 LOT DIMENSIONS SIDEWALK EXISTING YES 0 NO Q----- BUILDING GRADE ELEVATIONS STAKES SET AT SITE FEE: $2'OO~ 5-31 , I 95'2 BY k"'~ ~~ DEPARTMENT OF PUBLIC WORKS ~,~ 29'S1 q;S I 7/tJP the I, the undersigned, owner or agent of the abo grade establ ished before excavation has co enced. i I STATE OF WISCONSIN WISCONSIN UNIFORM OEPARTMENT OF INDUSTRY, LABOR AND PERMIT NO. HUMAN RELATIONS DIVISIDN.OF SAFTY AND BUilDINGS BUILDING PERMIT 201 E. WASHINGTON AVE. PARCEL NO. BOX 79tIll APPLlCA TION MADISON, WI. 53707 WISCONSIN STATUES 101.63 PERMIT REQUESTED ~ CONST [SHVAC I;)?ELEC o PLUMB on:'S Name ( ~"A(. f/J~ ~ Mailing Address Telephone AJfP e OliF- .5C~ Contractor's ~ ""21~OaiW;S;- UCi~/f.. aAD. TelePhon; . f . . 1t91.A. 5 c- H ':2...:1. - ~)..4> ~ PROJECT LOCATION % %, SECTION , T N, R E(or)W Building ~7dress H-..AM I LrtrtJ Sv- su;z.sion Name RA-'T Lot No. Block No. 024 - 0 U$Cf:t (C..{ €-,v,~V 3--z- - Zoning ~i: /4- I~rea I Setbacks Fron!.z . .1 Rear Left f:J. Right y. x.. I:U; Sq.ft. . 5 - ft. 71 ft. 7~ ft. I () 9-ft. 1. PROJECT 2. TYPE 3. ELECTRICAL 4. HVAC EQUIPMENT 5. ENERGY SOURCES ., Entrance Panel ~orced Air Furnace Fuel Space Water "'8New o Addition ~Single family Size: 100 AMP o Radiant Baseboard or Panel Htg. Htg. Alteration Two family Service o Heat pump LP Gas 0 0 o Garage o Other o Underground o Boiler . Nat. Gas f6I. g o Attached o Overhead o Central Air Condo Fuel Oil 0 o Detached 6. CONST. TYPE 7. FOUNDATION o Other Elec. 0 0 o Other Wood 0 0 o Master plan no. ~Site const. ~oncrete 8. PLUMBING Solar 0 0 (if applicable) Manufactured Masonry Coal 0 0 o Treated Wood Sewer Other 9. AREA ( Outside,) 10. STORIES Dimension o Other [jlMunicipal o Basement 160 .9 sq.ft. ~ 1-Story 11. USE o Septic o Permit No. 12. WATER o Living Area /009 2-Story DSeasonal sq.ft. D Other D Private o Garage ~ Permanent ~unicipal sq. ft. Other he applicant agrees to comply with the Wisconsin Uniform Dwelli ~~d other Municipal Ordinances and with the conditions of this permit;understands that the issuance of the permit creates no legal liability ,express Implie n the ~artment r Municipality; and certifies that all the above information is accurate. .~ ~ ~--Z::}--;~ SIGNA TURE OF APPLICANT )/?T~ < 'A ! ~ -'~ "\.. .--- DATE CONDITIONS OF APPROV AL This pe~mit is is~ued PU~1 uant to the following conditions. Failure to -comply m!ly result in suspension or revocatIOn of thiS permit or other penalty. ;;...:::-- 13. ISSUING JURISDICTION DVILLAGE ~ITY o TOWN OCOUNTY OSTATE NAME @'(~tr MUNIC. NO. ~ 0 - 2- ~ cc. - - - ---:- .... ... '.. ..... .... . ..... ... .' .' . ..' . . '.. . . FEES PERMIT(S) WIS. UNIFORM PERMIT PERMIJ..UjSUW BY .. ISSUED SEAL NO.lS) PLAN REVIEW $ - rnCONST. / ~ <1--5'0 ';;/-- ~l....'llJj .I b NAME INSPECTION ~HVAC I 3 -rs;c::> !--' s- Z.7-~3 WIS. PERMIT SEAL(S) 01") ~LEC 1.3</-s-D DATE ~ OTHER! .I OPLUMB I CERT NO. 3~~ -Vat? TOTAL $ .':'>v f1 f ~tY~ c.. 01 LHR-SBD-5823 ISSUING JURtSDICTION/AGENCY . '. . '(~I~f,\:'1 'r:':~?~7';:t ..... 0.: . ".:.'. .... .',:p,: . " '. .. I'~ ,.' " " I'. " I" I, . ,".' .: : ..' .....:... ,,':': ,,:.. '.1 : ." :" '. .....:,..... '.~~:~., ".:-: '. : ':.,. ~" ~,,';,; ~,." ~,::;:' '. . ..'S ':', ;. . ,;.'''..' ....... i.'.r,:( ; ',' -1" i,. :'; :: : ,..'. ,';_,' .. ' .: .: .' " . t'- <::1>:,(^. '.;:: .' I' . . . ' 'i:;,) '.,' . .~ ' V ~. 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