HomeMy WebLinkAbout03120104 Application Cazmel/Clay
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Township Application for � Pe�,�t No. a I d 1�7
Improvement Location Permit Date �;���/v �
Hold#.: Roll File
This pecmi[is va(id only if consttuclion is started wi[hin 180 days of the date of issuance for residential��consWC[ion;and foi commercial projects,within one(1)
.�ear of the date of issuance of the State Commercial Desi Release. AU conswcfion'must be com leted c;o issued)within 2 ears of the issuance date.
NAME PHONE PAX
B�LDER 1�� l�o �e,s Sn�-a 350 ��- s�� - �► n �a-
STRHET C1TY STATE ZIP
��r'J 0 � W�vl �.,�1- -#�530 Co��me! -�-{�J '-kl�D3�--
TENANT NAME
(Ifa licable)
NAME PHONE FAX
OWNER � l� �yy�,QS
�.
STREE7 CITY STATE ZIP , jq�
r
SC�.Yv�SL AS c�' D�� lU
LOT SUBDIViSION S6CTION � �
LocnTroN \`� 1-� ra�l� 4S`l�`f-QS � 15 ;���
ADDRESS OF CONSTRUCTION �
0 30 1'a�,�.b��r� C.v'�e.IL CrS '�
` A. T F CONSTRUCTION Do p ans mclude a porch? F. E OF IMPROVEMENT
1.�Single Family C�Pes❑No 1. New Struchue
` ' — 2. ❑ Two Family 2. ❑ Addirion: Porch Room
3. ❑ Multi-Family Type of Foundation 3. ❑ Remodel ❑ Commercial Tenant Space
4. ❑ Commercial/Industrial ❑ Crawlspace 4. ❑ Foundation Only----------
5. ❑ OTHER � Basement��A�� 5. ❑ Demolition � u���--�"`'��}�'�
(Specify) ❑ Slab Y�U ���� 6. ❑ AccessoryBuildin�EC 1 8 2003
B. SE�,�/R � �� � ��� -� 7. ❑ Garage Detached Attached
1. yq Public (Nameofsystem__�J. I�C�,I�,Q�
2. O� Private(Counry permit# � �) Lot Split LES_=NO=I/�
C. W.�TER: Flood Zones YES _ NO `�
1. � Public (Name of systeii�y�{J:p�S 1/JQ�.]i Sump Pump Y�V' NO
2. ❑ Private(County pernvt# ) ,. Manufactured Trusses ���I'ES`��— NO
D. ZONING : S'Z K. Plumbing Contractor_ `,0.YVlWb�V�5 �L
E. ESTIMATED COST O�CONSTRUCTION IRC Plumbing Code: ❑ Plumber's
(Excluding Land Value) �55a �a,�6� Indiana Plumbing Code: � License#:��Q O(9(� i 0 �
.+�.»«e«r»+a��r+:.rs.:.s«:+#s.rsrs+ �•.tr�*..*«rs#r*«�s.rs�.x.r�»+a..rr..+.«s�*�+*�r*»*.�+zr*a�*.+.rr#�.�*xr+
I,the undersigried,agree that any construction,reconstructioq enlazgement,relocation,or alterat' o�2 � �� etures
requested by this application will comply wi[h,and conform to,alt applicaBleiaws of the State of i�����Sn�r���eYlddi�fi�1993"
(Z-289)and amendments,adopted under authority of I.C.36-7 et seq,General Assembly of tlr�8�{€6�1�4di�4#,��Pfr4PP.�[$"�fedd�t�°lR�e`'to.n�'�'urther
certify that only kitc6en,bath,and floor drains are connected to the sani[ary sewer. I further certify that th@f�iSt1U'ctSri"xsbv�l#�'dE��if3Et'�occupied until a
Certifica�e ajOccupancy has been issued by the Department of Community Services,Carm�t�i�u�� �;i}�,�(,i¢'s��'�'"/ �e���,���1�4'=w
�'e� ` r`-'� '/ .J f\-�� N`Q���!(.Y' CR�"`�`�196R�tt"lr'[�I�S�'L"+ E�E,'D:iD't`tfY�V�Fi6f=
Signature of Owner or Authorized Agent �k��'t'('� Footin nder Slab � 'U gl'S�'�� eter Base �
L��a� K� e�, 5�5 � d 35o k �a- •�— �n � �
(Pri�t) (Phone Number) p Sq.Ft.._�'�_
Filing Fees: �d ,�� ���
E-MaiL• 1 �� • ����U..��. . e.tYwU BaseInspections:�
Cert.of Oceupancy: 02 cL� �l�
P.R.I.F.: � �/j�2� .(�J
Pla� omrttiss' cket#'s; TAC Date(s)
� ToT :
� �
Reviewed/Approved: Dept. of Community Services Fe eceived by S:Pem,�ts/Forms/i�PS-02