HomeMy WebLinkAbout06010032-Application =lay Township Permit #:~](/O /
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUTLDER of NAME PHONE FAX
RECORD:
~ NAI~'----'T~ PHONE PAX
OWNER:
L OCAT ON LOT# 1
J SQUARE
] FOOTAGE:
J PROVIDER: //~ ~,¢~.~ ,/ PROVIDER: (EXCLUD]NG~NDVALUE
J ~E OF ~L~ ~A~N CONT~OR, P~N COMMiSSiON / B~/~,PW DOCK~
~PE F C ,N R.~ON: ~PE OF IMPROVEMENT: I~B]NG CONT~OR:
~ S~NGLE FAMILY ~ NEW STRU~UR~
~ TOWN HONE ~ ROON ADDITION(S)
~ ~O FAMILY ~ PORCH ADD~ON(S)
~ of unJ~__ ~ REMODEL
~ NULT~"FAN]LY ~ ACCESSORY BU]LD]NG
~ of Units:
~_ RES]DEN~AL ~ D~ACHED GAUGE
(For ~ A~ACHED GAUGE ~
Additions, Remodels, Etc,) ~ DENOL]T]ON
EatJy ReJease V Manufa~ured for ~e new
Permit: Y ~N Trusts: Y ~N cons~u~ion a~a)
C~WLSPACE
PO~
Lot Split: Y ~ Sump Pump: Y ~N
~ S~B ~ BASEMENT
WALKO~: .Y~N_
w~r~n 180 days, of the dare of ~ssuan*~bd~ ~O~ficare of Occnpancy ~ued) ~t~n 18 months of the
issuance dare~ Class I structure permits are subje~~ ~¢~ules o~ the Stare >f indiana (See 675 IAC 12) regarding e~irarion
1, the undersigaed, agree that ~y consr[~ on o[ a structure, or ~7 c~ge in the use of ~d or
structures requested by this app~cario~ ~ ~h~~are of ln~ana, ~d the '*Zoning Ore.ce
~d~a- 199~~ (g~289) and amendments, adopted under aurho~ er seq, Gener~ Assembly o[ the Stare of ln~a, ~d ~ Acrs am~daro~
thereto. 1 [urrher cerr~y ~ar o~y ~rchm, bath, a~d floor &aing~d ro the sanira~ sewer I further certify that the construction ~11 not be
~ ~r ~up~e~ ~care ~ ~ccu~ancyhas been is~ rhe Depar~men~c~mmuni~y Services` CameL ~ndiana~
~pper F~in~ Lower Footing ~Under~ab "~ / ~/ ~ - ~eviews
~' * - ~ ....... -~' Ce~. of Occupancy: ~/. ~ u
Meter Base P. R,[, F,: Additional Fees