HomeMy WebLinkAbout04040199 Application
Application for
Improvement Location Permit
\0-
Carmel/Clay
Township
Hold#:
() /7t:f
This permit is valid only if construction is started within 180 days of the date of issuance for residential constructi ; and for conunercial projects, within one (1)
ear of the date of issuance of the State ConunerciaI Desi Release. All construction must be com leted c/o issued) within 2 ears of the issuance date.
BillLDER
NM.'~ ~ t-b-e-S PHONE 81-13-<15'1
STREEqZ 0 Z. N. rfuAtD\~~:n 0n
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FAX
STATE
ZIP
'-1 (j 011/0
TENANT NAME
(If a licable)
NAME
PHONE
FAX
STREET
CITY
STATE
ZIP
OWNER
LOCATION
LOT q~
SUBDIVISION
Law ~I +6 ' /!1 Ifu~
j 35<.1 & Lv re-(\W B( v'd
SECTION
ADDRESS OF CONSTRUCTION
TYPE OF CONSTRUCTION
L .);r"Single Family
2, IT Two Family
3, 0 Multi-Family
4, 0 Commercial! Industrial
5, 0 OTHER
(Specify)
B. SEWER:
L J;l--Public (Name of system
2, jj Private (COWlty permit #
C WATER:
L ~Public (Name of system
2, b Private (COWlty permit #
~..~
A,
Do plans include a porch?
~s 0 No
F, TYPE OF IMPROVEMENT
D, WNING:
E. ESTIMATED COST OF C
L di(New.8tructure
2, 0 Addition: Porch_Room
3, 0
4, 0
5, 0
6, 0
7, 0
ry B.uj)l!ing,
DetlMhliJd t. 7 2004ttac
G,
H-
I.
J,
Lot Split
Flood Zones
Sump Pump
Manufactured Trusses
'"
Site C!O ') .1/
7 sf 70 Sq,FrJ1S,/
Base Inspections: r2. (,0,00
Cer!, of Occupancy: <; 0 . C@
P,R.LF,; Sa 7, ()(/
(Print)
E-Mail:
Plan Co ~ZAlBP
Reviewed! Approved: Dept of CommWlity Services
's; TAC Date(s)
TOTAL:
/5 9~ '7Zf
FeeReceivedb~~ ~,~S/ILP5.Jj2