HomeMy WebLinkAbout06010030-Application~F'O14~/~ ~.~ Penmit #:
]MPI~O!Ft~lV[~N~ LOC~?ION P~ILMI~ APPLICATION
New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
PHONE FAX
RECORD: '-3~- _ ~J~S~ ~/~
STAYE
BUILDER~ EHA~L ADDRESS
BEET METHOD OF CONTACT:
PROPERTY ~*~E ~ PHONE EAX
OWNER: I/a ik~}4,
~ ~ crrY STATE
~m ~CAT~ON ADDRESS OF CONSTRUCTION. SUITE # (If Appflcabie)
& PRO3ECT
lrNFO: AddressofSheflBuildlng(Zfd~ereni:thanAddressofConstruddon) / Lot#andSubdJvJsion (IfAppflcable)
L
BUILDING, PRO3EC1F, OR TENANT I~Af'4E: ] ZONING: [ TAX fcC, P PARCEL #:
DESIGN RELEASE #: RELEASE: /~, ELEC C SPKLR OTHER(S): FOOTAGE:
SEWER UT[UTY ~ ,~ I ESTIHATED COST OF CONSTRUCTION:
PROVIDER: PROVIDER: ~ (EXCLUDING LAND VALUE)
PLAN COHHZSSIOfl J BZA / BPW DOCKEr NUMBERS; AND/OR
COUNI~ WELL AND/OR S~PT[C PERNIT #'S ',If Appllcab~):
#ofReors: ~.~ EJevat0torUft: [~ YES ~ 8LDG. CONSTRUCT[ONTYPE:
F -_i~ ~_ : -P -_ -~ .EMENTI
[~ MunJdpal/~)~~ ~]~'" C~l~:rquDEL'
[] School ~ ~: ~
[] Church CI~~ O
,, ~ ACCESSORY BUILDING
~: (Check all which ~ ~ETACHED GARAGE
apply t~r the new oonstrucUen area) [] ATTACHED GARAGE
~ SLAB [] CEAWLSPACE [] CELLTOWER(New)
[] POST & BEAM [] BASEMENT [] CELL TOWER CO-LOCATE
(or POST & PIER) WALKOLrr: Y N [] DEMOLITION
289) and amendments, adopted under authority of I,C, 36-7 et seq, General Assembly of the State of Indkana, and all Acts amendatoty thereto. I further certify that only
Occu~bstata~o~ has been issued by the Department of Community Services, Carmel, indianm
Signa mofOwne or isthorizedAge Oate
EaHy Release Y -- ~ N Manufactured
Permit:. Trusses: Y
Lot Split: __Y_~N Sump Pump: Y
Does any part of the prope[ty~lie within a special Flood
--
designaUon area. Y
~LUMB! G- - NTRA: OR:
~ L. L~&-
Plumber's Indiana State License #:
OFFICE USE ONLY.' **************
INSPECTIONS REQUIRED:
Upper Footing Lower FooUng
evie ed/Apprc~ed: Dept. ofCommu~'b/Se 'ces j (Date)
Base Inspections:
Cert. of Occupancy:
TOTAL:
Fee Received
# Char~ed Re-
Reviews
Additional Fees
/