HomeMy WebLinkAbout1311.02 Application„c, ay
, uwnship
Application for
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4'ermit Na.
Ho�a �:�������. �;,�, Improvement Locatiot� Pernzit nate _ __
Rall Filc
7his pernait is valid only if construction is staried within 180 days of the datc of issuance for residential construction; and for commea�cial projects. �� ithin one { I)
ear ot the date of issuance of'the State Commercial Desi it Relcase. All construction must bc com leted [c'o issuetl) �v�t}�fn 2 vears of the issuance date.
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BUILDER � V�lt� ���5���`�` � c. �3l?-G23'�,��5� 3f7- $23` (Q
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TENANT NAME
{1f a iicat�le}
�AML PHOti'E �j�A\
OWNER ��V� � P�� 1S
STREET CITl'
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i_oT su�r�n�isio�� sec� io��
LOCAT'TON r �.. �� �� c�� i�
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AD�RfSS OF C6I�STRL'�C�f�iOV i� _�.arY
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A. TYPE OF CONSTRUCTiON Do pia�is incl de a porch° F. '1'YPE .OF,IMPROVE:�'IENT
1. ❑ Sizlgte Family ❑ Ye��lo l, New 5ti�ucture
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2. ❑ Two Family ��� 2; .` C7 :Additian: Porcl� Room
3. ❑ Multi-Fanuly Typc ot' Foundatio�i 3, ❑ Reniodet CJ C,onunercial Tenant Space
4. � 7 Commercial / Tndustrial ❑ Gawlspace 4. ❑ Fotindation On(y
5. ❑ OTHER ❑ Basement ' S. ❑ Dernolitiocl
(Specify)_ __ � Slab 6. ❑ Accessory Buildii7g
B. SEW� : 7 0 Garage 17etached �ttached
I. �Public (Nanie of system � (.� � l�✓�,) �;'. /
2. �❑ rrivatc (Couniy permit # �_ ) - �';,'' Lot Splik YES NO ✓
C. WATER: , I�i? Flood 7ones I'E5 NO ✓
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1. � Public (Name of system���.� ) ,_'� SumA Pump YES tiQ�—
2. � Private (County pemvt #' ) 7,�, Man�factured 'Trusses YFS �';�f0
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D. ZONING : '�,,��, K, Plumbin Contractor
�� E�TIMATED COST OI� CONSTRUCTIO� L, `� IRC 1'lumbing Code: ❑ Plurtfbe�'s ���
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��� (Excluding Land Value) � � ` � � � ; Indiana Plum�ing Code; � License #: � �� ��� � � � �
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I, the undersigned, agree that any construction, reconstruction, enlar�emcnt, relocation, or alteratiorz of a struct�ire, ar any chan�e in the use of land or structures
requestcd by this application �yill camp!}� ti��ith, and conform to, al1 apglicable la�vs ofthe 5tatc of Indiana, and the "Zoning Ordinance of Carn3cl Intliana- 19)3"
{Z-289) ar�d amendments, adopted under authority of I C. 3Ci-7 et sey, Gencral Assembly of the Statc ot� Indiana, and all .Acts amcndatory thercto. I further
certify that nly ftchen, bath, and f�oor drains are connectcd to the sanitary se���er. 1 iurther certify tEiat t}ac coustruction �i�ill no! be used or occupied until a
Certifrca n' ccupa��cy l�as been issueci b�� the De�artment of Coror�x tr Ser-vices, Carmel, 1»diana.
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fgnature of Owncr or .Authorized Agent ��� �� Footi�xgl tde � �}t-In �—��Teter B�se
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c��L'- r3 vti - L�aSS ��e51 �--.�� �� „ Site �' Final � CIO
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(Print) . . (Phone Ntimbcr)_ �'`L�y `i�� ��' Sq. FI. � ��:>�.'
��;f �' ��, Filii�g Fees: �� ";.:`� � .
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,�F-Mail: ���asS Q �~'���-�� �C.� � �fBaseInspections: ,. - _
�lan Conir�ission/BZA/BPW.Docket #'s; TAC pate(s)
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Reviewed/A proved: Dept. of Conununiry Ser�°ices
Cert of Occupancy:
P,R.I.F.: �
Fee eccived by
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S,Permits FrnYns.li_P�-0?