HomeMy WebLinkAbout06010027-Application
BUILDER,of
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
WATER UTIlITY
PROVIDER:
City of Carmell Clay Township Permit #: Oh/J / OO';J. 7
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION/
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
NAME _
1I1;t!./Il4EL c S7CVfii=72
STREET ADDRESS
69, ) r!cCKtdC,J
BUILDER'S EMAlL ADORES .
IJ/... YIk~CJ
NAME
/J1,E 1\1?::7?- LIU<! .
STREET ADDRESS
1J9 Wif'-Ki2;Q
ADDRESS OF CONSTRUCTION
W. e/ftfJ1EI- 01.
PHONE
(70).5(.+ 9831
FM
17 Sbl- ~"'ICj
STATE
It//!
CITY
IttI1<I2IS &/A?G
BEST METHOD OF CONTACT:
CBL# fin 350- 001<J
ZIP
17111
PHONE
FM
CITY
6-/VtJt.()
.'1/11 IJS
STATE
mr
ZIP
ifq~L/t{
sum # (If ~ppllcable)
O/.I9IIJ/J1/t4..S 1/()0~ /J1E/.JtX ,f77'.YZ6
/IE P (,I).
Address of Shell Building (If djfferent than Address of eon1ction)
Lot # and Subdivision (If Applicable)
TAX MAP PARCEL #:
o STR 0 ARCH 0 MECH 0 PLUM SQUARE ~
ELEC 0 SPKLR OTHER(S):~ ~ W/J{1 FOOTAGE: lIiiiljIiIl: 6275
SEWER UTIlITY
PROVIDER:
ESllMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE) 7500 , (X)
PLAN COMMISSION / BZA / BPW DOCK NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors:
\
Elevator or Uft: c;:I YES ~o
OCCUPANCY CLASSIFICATION:
BLDG. CONSTRUCTION TYPE:
TYPE OF CONSTRUCTION: ~ TYPE OF IMPROVEMENT: PRO E RMATION:
116 COMMERCIAL ~I.~/ 0 NEW STRUCTURE ONSi?r.'yl ~~5 \/ Manufactured .
f'\ (Prtvatelyowned hospitals V 0 AQJ1[f1\ll't\ FOR ,C 'tn !i\\ntllW _Y ~N Trusses: _Y ~N
and medical offices/centers l~ IEL\f:&YR6OmrshlianCe W' -V '--.
are commercial) I'\!V . t(J>o;fl,nr~ d'loca\ a:.M~Plit:,\Gf$' --LYN Sump Pump: _Y ~
DIN ubI "" an 8\1",.. .. .
~~i~~~I/PUbIiC Bldg ~ R~ ~ORi\i;"e W: ~ N\ID~~VJI~-;;!'fI~e property he WIthin a speCIal Flood
. 0 School i'iIh~~ O\lWlSl'l_1 C\~si&~li~~-area: _Y AN
o Church ~. ~rNG fPLUMBING CONTRACTOR:
FOUNDATION TYPE: (Check all which g\ CHED GARAI>~ \p.N ;;
apply for the new construction area) 0 ATTACHED GARAGE /1) '4
~ I
Jl'I SLAB 0 CRAWL SPACE 0 CELL TOWER (New) Plumber's Indiana State License #:
o POST & BEAM 0 BASEt.;E1IT 0 CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOUTION
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for
beginning and completing construction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use of land or structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana - 1991''' (Z~
289) and amendments, adopted under authority of I.c. 36~7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
Occu 'Yor ubstantial CompJeti n has n . sued by the Department of Community Services, Cannel, Indiana.
Z )11({!!I19I:::-L E Sl()u,crt;,Je
Signature of OWner or Authorized A n
I 13/06
Date I
Print
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: Filing Fees: 326. zs- .
J -1 f'; # Charged Re-
UPpe~oting Lower Footing U,nder Slab Base Inspections: t, d ,.. t.. ~ [) Reviews
~~ Meter Base SJ Site Cert, of Occupancy: ' t) ()
~ .~ '2/),,,/0'