HomeMy WebLinkAbout06030021 Application
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City of Cannel/Clay Township \.J- Permit #: O~03t>f);H
RESIDENTIAL IMPROVEMENT LOCA ION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Family: New Structures, Additions, Remodels, &. Accessory Structures
BUILDER of
RECORD:
NAME
STREET ADDRESS
90 2';
PI
PROPERTY
OWNER:
NAME
STREET ADDRESS
LOCATION
&. PROJECT
INFO:
LOT #
)
SUBDMSION NAME
5f-.,.A (:.?..(
ADDRESS OF CONSTRUCTION
SEWER UTILITY WATER UTILITY
PROVIDER: C T;( IJ () PROVIDER: ('; /'L '" -< I
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUmY WELL AND/OR SEPTIC PERMIT #'S (IF APPUCABLE):
TYPE OF CONSTRUcnON:
[D....-sINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
TYPE OF IMPROVEMENT:
8"'"NEW STRUCTURE
o ROOM ADDmON(S)
o PORCH ADDmON(S)
o REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLmON
PROJECT INFORMATION:
Early Release
Permit:
PHONE
Cf6 296-L
FAX ;-Y6~ 'f2..1.-y
STATE
ZIP
(j
FAX
CITY
STATE
ZIP
fi:
SECTION
ZONING:c1? 2......
SQUARE
FOOTAGE: 56 f
E ATEO COST OF CONSTRUCTION:
(EXClUDING LAND VALUE) ,,;! OJ. f) (/ iJ Q ~
-e tC-t Q .(.
PLUMBING CONT . CTOR: q.. '\: ~..o
Ec;,A-1 t><'i~ ,,~~
Plumber's Indiana State Li ense #: ~. ~..o
/0>- 7()7 ~~\.
Which plumbing codes will be appJied to the construction: "';:;' ~
~emational Residential Code w/lndiana Amendmen~
o Unifonn Plumbing Code w/lndiana Amendments
(Multi-Family Construction COde)
Manufactured ,/, FOUNDATION TYPE: (Check all that apply for the new
.' L L/v construction area)
Y - N Trusses: Y N
- L./.: ~ (]YCRAWLSPACE 0 POST & BEAM
Lot Split: _Y _N Sump Pump: _Y _N ~LAB . ~ASEMENT
Does any part of the property lie within a speci\l\~~~,~!ll~ ~s:Hill~N WALKOUT:_ Y""::::::::-N
For Single Family and Two Family dwellings, additions, ~e~i81l.Rd76J!lljOli.18~iOOllr.N&!~arYffid,only ifC?ri~t",c.ii~n com,mencrs
within 180 days of the date of issuance of the building permit, an(tnr&m:6e'aOmplf:ted~t:Softes:e ofp~f~nc:;y ~~edr_~hin-18 moiii~s'of ~he
issuance date. Class I structure permits are subject to t~e .:J\:InllrettmrrJ.\..,''ffr1Y'o:SEJ:qa,m ' . . (See 675 lAC 12) regarding e"P." I9-tl. :on
tune fram ~llJll.ng,an~ <i~leu.n.g cons~cliblt.' " " I \ ~ \ i.
It the undersigned, agree that any construction, reconstru' argE"ment~RrB8atlbn/oLt.1~'6oIQ '. any ~b.SIge_in tPe~€~ lan~ ~r ; :
structures requested by this application will comply with, and conform to, all app~~~p~~ of the State of rrW'E\ ~d tMA00ning'6rd.inance of ~.~el
Indiana -1993" (Z~289) and amendments, adopted under authority of r.c. 36-7 et seq, C:;enerifAssembly of the Stil.t f Indiana, and all Acts amendatOrf '
thereto. I further certify that only kitchen. bath. and floor drains are conn. eered to the. sanitary sewer. I furthi ~ the-eonstI'Uctlon.-Will not be ~
use~or occu ied until t.::AiFicate of Occupancy has been issued by the Department of Community Se l es, Carmel, Indiana. .. _..._.-.-.. ,
or~1? I. 6-j'OC.E }--}-of,
Signa of Owner or Authorized Agent Print Date
OFFICEUSEONLY:***********************************************~t*J*********************
Filing Fees: '1t:.C:j.,.... '7'0
INSPECTIO REQUIRED: ., /' A
< Base Inspections: c-,/ 6 7. ) 1/ # Charged Re-
Up r Footin Lower Footi r Slab ..- ..- A ReViews
Cert, of Occupancy: S I .J (/
P.R,LF.: /;<., 61 (; ()
,4,.~T~r~7'Sy
Site
Reviewed proved: Dept. of Commu ity Services
S:Permlts/FormsIILP RESIDENTIAL
(Dale)
Additional Fees