HomeMy WebLinkAbout46624 BLDG (New Home) Wisconsin Department of Industry, WISCONSIN UNIFORM BUILDING APPlication No. �
Labor and Human Relations PERMIT APPLICATION
Safety and Buildings Division
P.O.Box 7969 (See instructions on back of pink copy) Parcel No. �
Madison,WI 53707 The information you provfde ma be used by other government agency
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Buildin A dress Subdivi on Name Lot No. Block No.
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Zoning District(s) Zoning Permit No. Front Rear left Right
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ew ❑Repair ingle Family Entrance Panel orced Air Furnace Nat L.P Oil Elec Solid Solar �
❑Alteration ❑Raze ❑Two Family Size:�amp ❑Radiant Baseboard or Panel Fuel Gas '
0 Addition ❑Move ❑Garage Serv ❑Heat Pump '
❑Other(print): nderground ❑Boiler
Space Htg ❑ ❑ ❑ ❑ �
❑Overhead ❑Central Air Conditioning Water Htg ❑ ❑ ❑ ❑ ❑
❑Other ;:.,: ❑Other *�
Dwelling unit will have 3 kilowatt or `
�" $T'��"'�"' °'�����' more installed electric s ace heatin e w . _
ite Construded oncrete P g q P ;
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❑Manufactured ❑Masonr �
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❑Treated Wood air infikration barner
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❑Plus Basement ❑Private On-Site Well $ ����Q�
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 creates no legal liability,express or i li ,�„the Department or municipality;and certifies that all the above information is accurate.
APPLICANT�S SIGNATURE DATE SIGNED �—! "9',�
APPROVAL CONDITIONS This permit is issued pur uant to the following conditlons. Failure to comply may result in suspension or
revocation of this permit or other pe�alty.
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Plan Review $ onstrudion
Inspectfon $ ❑HVAC Name � /' f c,,�
Wis.Permrt Seal $ '�C ❑Electntal �
Other $ ❑Plumbing /���� Date
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Total $�_ ❑ Cert.No. �
SBD-5823(R.06/94) WHITE-Issuing lunsdiction YELLOW-DILHR GREEN-Inspector PINK-Owner/Agent
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MASON CONTRACTOR ZONE
;� Width of lot DATE INSPECTIONS
' REMARKS
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MAILItvG ADDRBSs
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