HomeMy WebLinkAbout04090050 Application ., Carinel/Clay ,q �
Application for � �No����7 �
Township /��
'� ��� Date
Improvement Location Permit ��'��'�
�U,J RollFile
This pemut is:valid only if construc6on is started�within 180 days of the da[e of issuance for residen[ial construcfion;and for commercial projects,wi8tin one(1)
ear.of ihe date of issuance of the State Commercial Desi Release. All conswcnon must be com leted. c%issued within 2 ears of the issuance date.
NAME � PHaNE ppX
BU�.DER �tr� �' y6 E�� � s� t- � r.�s
STREET STATE ZIP
� � �-.'�- g2fi aRc( /��A-�-2 033
TENANT NAME �!� . , 0
(Ifa ]icable V���
NAME �,�_ py� PHONE Fp7�
PROPERTY �TJ/1'1"`�`
OWNER
STREET CITY STATE ZIP
LOT SUBDNISION SECTION SQUARE �
LOCATION Cj 2 (/ I LL( � W Q'+��' C '2� FOOTAG��J'_✓f--�'
ADDRESS OF CONSTRUCTION
I 8 6 fl L�/� _
A. TYPE 9F CONSTRUCTION Do plans include a porch? F. TYP�E�O ''IMP � � ��
i. �' Single Family ❑Yes�(No 1. B" .New S
2. ❑ Two Family 2. ❑ Additi rdf—'-1 o�om
3. ❑ Multi-Family Type of Foundation 3. ❑ Remod Commercial Tenant Sp e
4. ❑ Commercial/Industrial ❑ Crawlspace 4. ❑ Founda Y SEP 3 2004
5. ❑ OTHER � Basement(watkout� 7v ) 5. ❑ Demol'
(Specify) ❑ Slab 6. ❑ Access
B. SEWER: 7. �' Garage Detached AttacHed�
I. �ublic (Name o£system C[�f WA�'�
2. ❑ Private(Counry pemut# ) G. Lot Split YES NO
C. WATER: � ,, � (/ H. Flood Zones YES �.�/NO�
L EY Public (Name of system G��"fl�� ) I. Sump Pump YES V NO— L
2. ❑ Private(County pernrit# ) J. Manufactured Trusses YES NO V
D. ZONING : �U �f K. Plumbing Contractor LC�..S ��(m�
E: ESTIMATED COST OF CONSTRUCTION IRC Plumbing Code: ❑ Plumber's A u
(Excluding Land Value) � $g p, t��j Indiana Plumbing Code: � License#:�U /G d v v� /
+�s+«.��r*<»�+s��«�«.<«��.�rrr«��:� .���s���������������� � �* � ����
"�L`�.� �1! t�"C.�"r"�'Y���t�i'i8i�
I,theundersigned,agreethatanyconstruction,recons[ruction,enlazgement,rebcahg� �r�t�ppp�'���q���ygh���n�t�k�euse�flandorshuctures
reques[ed�by this application wtll wmply w�[h,and confortn[o,all applicable laws of the�tate o{'T �],�y�y,y�d Zoni �rd7/]�e o�'��nn�el Indiana-1993"
�Q .SfBt"' ^ tc Y.�fY^. . '1<Fna
(Z289)and:amendments,adopted undei�.au[hority of I.C.36-7 et�seq,General Asse�Y�g� t { �i�n and�Accs•3mendaro thereto. I further
certify that only kitchen,bath,and floor drams are connected ro the sanitary er. I�fffrthEr te� t��t�FK'�EFio�����fi'ia�'tir occupied until a
Certificdte.ojOccupancy has been issue� b the Department of Co unity Se�vl���inf'y��A��, / CLAY TOWNSHIN
`'� IN��9A�iS NEEDED:
.
Signamr of O er or Authorized Agent �u �� UpperFoo m . Lower F Bonding/Grounding._(#)
/
���b/J� �O e�, � � (� 8'�� I' Under Slab Rougti��I Meter B e Final Site�
,t
(Print) (Pho Number)
Filing Fees: �
#Charged Re-
E-Mail: Base Inspections: . Reviews
Cert. of Occupancy: . � �
PI Co 'ssiu A/BPW Docket#'s; TAC Date(s) P.R.I.Fi: � � � Additionai Fees
�oT�.: . 8'33, �'U
Reviewed/Ap ved: �Dept..:ofCommuniryServices FeeRecei d�by S rtnits/Forms/ILP3-04
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