HomeMy WebLinkAbout05120083-ApplicationRECOR[I
City of Camel/Clay Township
IMPROVEMENT
Hulti-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
PHONE FAX
PHONE
CONTACT:
FAX
OWNER:
LOCATION LOT #
~UBDI~IS~ON ~AI~
STATE ZIP
INFO:
SEWER LrFILTIY
PROVIDER:
WATER UTILITY
NAME OF I]HLITY EXCAVATION CONTRACTOR; PLAN COMMISSION ! BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEFrIC pERMiT #~ (IF APPLICABLE):
- --: N -'_ --~:
~ SINGLE FAMILY
~TOWN HOME
TWO FAMILY
# of units:
[] MULTI-FAMILY
# of Units:_
[] RESIDENTIAL (For
Additions, Remodels, Etc.)
PR- -= -- - - -:
Early Release
Permit: __ Y ~/N
SECT[ON
~'~-~D COST OF CONSTRUCTION:
L (EXCLUDING LAND
ZONING:
SQUARE
FOOTAGE:
Renews
AddiUonal Fees
Filing Fees:
Base Inspections:
Under Slab
Cert. of Occupancy:
Final Site
P.R.I.F.:
LotSplit: y_~N SumpPump: _./~___Y N [] SLAB ~' BASEMENT .
Does any part of the property lie within a special Flood designaUon area: Y ..~__N WALKOUT: Y_Z~___N
ena Two
within 180 days of the date of issuance of the building permt , p
issuamce date. Class 1 structure permits are subject to the General Adlmmstractve Kules of the State of Indiana (See 675 IAC 12) regarding expiration
time frames for beg~ning and completing construction,
I, the undersigned, agree that eny consU:uction, reconstrucuo, n, ~e~gemcu~ felon..a~o,n,,or alt~a, uo~ o! a _s~ .t~_c~..~ r_ej o~_ ~en.y. = .c~g~ ~.~a~Ofcel oof?a~me1
indiana- 1~' (Z-289) end amendrarmts, adopted under authority of I.C. 36-7 et secL, General Assembly of the State of indiana, end all Acts amenoato~y
thereto, I far.er cexdfy that only kitchen, bath, and floor dra~. s are connected to the sanit ~a~sewer. I. ~r~ h~r_. ~ ~a~ha~ ?n~d~n~t~uc tion will not b~
used or occupied pntfl~rrcJ/~ca~egfOcc~cyhas been lsened by the Department Ol ~ommumty ~rvtces, ,
='~na~re o~ Ow~r orAu ltz~-Agent ~ Date .
--:: F :---', E-:: )El ~ =
{~NEW STRUCTURE
~} ROOM ADDT~ON(S)
[] PORCH ADDT~ON(S)
[] DI~.~[~ED~ ,G~:~E ;r , ~,ndmen~
~ A~ACHED ~ ~ ~ kme~men~
Tm~: Y ~ N ~n~on ama)
~ ~W~PACE ~ ~ & B~M