HomeMy WebLinkAbout06020098 Application
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City of Cannell Clay Township Permit #: ()& b J.. O(Y1fr
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NA E
t~)tA~
STREET ADDRESS .../
5$" ."L'"L - sr.
toJ ,;)1"fNt.-f'\v"/
CQ.
PHDNE
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FAX
31'1 - '1l."H,l:rS
OTY
:J:.tO P\.-5,
BUILDER'S EMAIL ADDRESS
l.....1 (PH ti) WMmst. V\t+
PROPERTY
OWNER:
NAME
C. A.ec L..
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LOCATION
&. PROJECT
INFO:
i),!!
SUBDMSION NAME
c;,~t.lrJ'\{r.E.~
ST1TE
~'"
ZIP
'-+If'Z-O"Z..
BEST METHOD OF CONTACT:
t~l\ Ml- 'to -,&,1iJ
PHONE
3 11- S"~().. 1~ 0
FAX
CI4
CITY
~L.
ZIP
4-~032
ZONING: /\
K-i
SQUARE
FOOTAGE: l ~ 2..
:::r:r
.lB.
SECTION
3
Manufactured FOUNDATION TYPE: (Check all that apply for the new
_Y 'fJ N Trusses: _Y X N construction area)
v7 8 CRAWLSPACE 0 POST & BEAM
Lot Split: _Y p..-N Sump Pump: _Y >(" N 0 SLAB 0 BASEMENT
Does any part of the property lie within a speciaU'lQod designation area: _Y ~N WALK9UT~"<'l':::-~ N
_. ..<..-. ,.," , " -,-. n ,. .-- \,-,':
For Single F~y ~~T~O'Fanill~''''d~btllri~;:~~4i~b~~.::f~?f1~I~,'.~dJor accessory structures, this_~ii'vaud;~I;~it}~~nifirOf\enhhences
. within 180 l!.~y~~?r~l:\e ~tf,P.~ ~u~ce:of the.o.u~~_~g)~eririit:~d m~s~ be c~mpleted (certificat~1~f~~ai;CYj~Ued}Within 18 myi h~ lli th~
ISSuance date. 'CI.3SS 1.5. tru ..~:t~~~.~,~,ts, \~~.,~..9~~t.t6the'Ge ~e~;A..1~ .rmlllstratIVe Ru~es of the Stat~,<?~ If ana (See 675 lAC 12) regard - \ :hkatIon
, l;, '--"'..',.~.., ", '\ ""ipp1~fr~foii~gtJUlmgandcompletlngconstructlon> '} 'moO \
I, the undersigne4;agreft~any,oonsthicikni~~~~~WQ~~, relocation, or alteration of a ~~ e, ocmh~ghn ~e use of
structures requdti~' l)y.this ~,lic~OJi!;Will c!o~, \md ~~~ t~,;all applicable laws of the State &lIhdi a, aActthe "Zoning Ordinanc el
t:"),,; \i '" j'-; A;;n'"I'-'';&~ ~~1 \
Indiana -1993",L 209 rand enamqFs,\';w, nder authOrity of I.e. 36-7 et seq. General Assembly of "\'IS S\!~~ Indiana s amendatory
thereto. I further certify that only kitcli~l:ia , cffloor drains are connected to the sanitary sewer. I further ce . "tliat tl:: construction will no
sed or oc pied until a Cerci/icace of Occupancy has been issued by the Department of Community Sdrvices, Cannel. In .
J (.f( f.SI-\'Oj,()SI<-'1
OFFICE USE ONLY: ** * *** **** ************** ** ************** * * *** * **};.*,. *jl'{ * **** * *** ***** ****
Filing Fees: /,) L J.tf'
INSPECTIONS REQUIRED: ') .J.-;"\
Base Inspections: (; n. J U # Charged Re-
Upper Footing Lower Footing Under Slab I ~/ ""'-:0 ReViews
~ Cert. of Occupancy: '4- ':)
Meter Base /"Final sit~
C..:.:.: ~ P.R.I.F.:
C.I4RMcL .J:rl
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WATER UTILITY
+i PROVIDER:
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); ANDIOR COUNTY WELL ANDIOR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF CONSTRUCTION: PE OF 1M ROVEMENT:
0 SINGLE FAMILY ~O NEW STRUCTURE
0 TOWN HOME - ~D\"e 0 ROOM ADDmON(S)
0 TWO FAMILY \~1-1\(g ~ PORCH ADDmON(S)
# of units: REMODEL
0 MULTI-FAMILY 0 ACCESSORY BUILDING
# of Units: 0 DETACHED GARAGE
~ RESIDENTIAL (For 0 ATTACHED GARAGE
Additions, Remodels, Etc.) 0 DEMOUTION 0
PROJECT INFORMATION:
Early Release
Permit:
rized Agent
Print
c..
Reviewedl Appro : Dept. of Community Services
S:Permits/Forms/ILP RESlDEffTlAL
-06
Fee Received by:
ESTlMATED COST OF CONSTRumo~:
(EXCLUDING LAND VALUE) 'f .} '5{ (JO -
"1... -1-"2. -O/'
Date
Additional Fees
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