HomeMy WebLinkAbout0405.01 Application i
�?Y 6` PermitNo. ��� � ��
,.ow�s ,P ���, Application for Date_�
Improvement'Location Permit � R°u r'ie
��
This,permiLis-valid only if construction is stirted within 120.days of issuance date; all construction is completed(do issued) within 2 years of issuance
datevnless�an extension'bf time has�been officiall � nted b� letter b ��.the.Direcior,�De artmen4 of Communit Services.
NAhtE PHO�E FA%
B�LOER �iU�oc��. /-3��ra
srue /n ��`f ^� c�rr _J �n ' ' J/�Tnre� rir
��)�� �/ /V ���UO
TENAN b'NAME GO�S�CP`� 0�\�l1�h`'
N . PxohE ��PSE�mP��an��o�a\�p ��'�\�+ ,�`�
OW:VER P,E. lo ca e b�d -(`y J� F�*
STREET /i CITY �U ��F G� 7'A'ItiG 'I.IP
�� 1.
LOT SU�B V� �I Y/ 'A�/ � �j l G�\ ' SLGTION
LOCATION �� (/Yl.('S(/vI U�- �`a�
AODRESS OF CONSTftII ION
O� `�G1�e�-e: �z�s ��,�\`�",�
A. TYPE OF+CONSTRUCT[ON Do,plans inclu a porch? F. TYPE OF IMPROV��%T ``�� U ��
1. � Single Family ❑�Yes�o 1:���New Struc App
2. Two Family � 2. ❑ Addition: {�o Cp- IL6o�
3. ❑ Mul[i-Family Type of Foundation 3. ❑ Remodel ❑ C ercial Ten ac
� 4, ❑ Commercial/Industrial ❑Crawlspace 4-. ❑ Foundatio I
�5. ❑ 'OTHER �asemen[ 5. ❑ Demolition
(Specify) Siab 6. ❑ Accessory Building
7. ❑ Garage Detached Attac
B. SE}VER: /�1J�yy�����
1, �Public (Name of System yi/ /�� ) G. Lot Spli[ YES _ NO �
2. ❑ Private(Sep[ic Tank, etc.) H. FIooJ `Lones YES NO X
C. WATER: j I. Sump Pump YES � NO
l. e�Public (Name of Syste � � �S) J. Manufac[ured Trusses YES NO
2.l❑ Private(Well ) ���5 P/u',Y�'1��
D. ZONING : K. Plumbing Contractor
E. ESTIMATED COST OF C NSTRUCT[ON {�
(Excluding Land Value) C�� J Plumbing License# ��O ❑ UPC or;$�CAI30
rr.«..�...+++*a+»�+++�+.+.+, �*«���*«+r�., +..«+++..+++*r++++.+.:+.:++�*�+r�.r�r+w.+..+.*+�+�r+r+.+.+..++*+✓a�
The undersigned zgrees that any constructioq�reconstruction;enlargement,relocation,or alteration of structure,or any change in the use of land or stmcmres
requesred by this application will comply with,and mnfomi to,all applicable laws of the State of Indiana,and the"Zoning Ordinance of Cartnel fndiana- I99J"
(Z-289)�and ameridments,adopted under authority of I.C.36-7 ct scq,General Assembly of�hc State of Indiana,and all Actsamendatory Ihereto. I further
certify that.onlyk�tchen;bath,and floor drmnsare.connec[cd.to�the sanitary.sewer. 1 Tur[hcrtertify that�he construction will no[be used or occupied until
a.Cert �ca�e aJQccupm�cy h �be n.i ued by�the.Department of Communi[y Services Indiana.
ECTIONS
� �� CAL pP 928-6 S � '
. Q m Under Slab -In M1 [er se
Signafure of Owneror Authoriz d Age t P�C�
/�� ��R Sile ,... C
���QY ���JC{1 l �"��/�/ � Permit(Square Footage) t}OZ po S��
�in[� (PhoneNumber)
Inspection�Pees: 3�D0
SewerCapacity,Allotted �b-� . Certificateo£Occupancy: 21•Oo
Plan Gommission/BZA Dockef#: P.R.I.F.: ge(-pa
T07'AL: � �S5YD0
\ Revieweci/Appr ved:, DepL��ofCommunityServices I�ee ceivedsby id��^""'�°.�':'r��""'°"�-on
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