HomeMy WebLinkAbout06050002 Application
BUILDER of
RECORD:
"~'-\V \C\u.~ II L~. ,~n.t __
City of Cannell Clay Township \Y ~ Permit #: 6& 06 !J/Jn 'J--
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, &. Two Famil : ~r:...w Structures, Additions, Remodels, &. Accessory Structures
n /":"(0.. [.if. /I' ~ PHONE
K".,J~ ,,' f:./J--wrc. c3;>l. -1,;;/- 0 ---;c;^-f
!:~V
.'?i!jtl
NAME
,;:r;t,";ie..
FAX
nn
6.J<e.c
CITY
~c;,lle
STATE
ZIP
~
-'/6/'7
BUILDER'S EMAIl ADDRESS
BEST METHOD OF caNTACf:
PROPERTY
OWNER:
NAME
L~ s,r:.i){I
STREIT ADDRE~
34.0 J-1 \.;;,,w"'\L
PHONE
FAX
CITY
STATE
.2fJ
ZIP
^-I00~ .
LOCATION
&. PROJECT
INFO:
LOT #
SECTION
Z;ONING;~
C'''?C' ,
s~........._",.
P VI .
ADDRESS OF CONSTRUcrrON
~b 3iUP-i~ .cU,'" e r:!.-, <2-dc.-
0...:, '.J WAITBJl~''-'" ~~, ...t;:?
. -PlWVu:iEI . , "
!i>'1-'~
ESTIMATED COST OF CONSTRUCTION:
(EXCLUDING LAND VALUE)
SQUARE
FOOTAGE:
~
-
17-
~ o~o
NAME OF UTIUTY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA I BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WEll AND/OR SEPTIC PERMIT #'S (IF APPLICABLE):
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
o "'poRCH ADDITION(S)
(3' REMODEL
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
PLUMBING CONTRACTOR:
1 ~Iumber's Indiana State License #:
TYPE OF CONSTRUCTION:
~'SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units:
o MULTI-FAMILY
# of Units:
o RESIDENTIAL (For
Additions, Remodels, Etc.)
Which plumbing codes will be applied to the construction:
o International Residential Code wI Indiana Amendments
o Uniform Plumbing Code w/Indiana Amendments
(Mulb-Family Construction Code)
PROJECT INFORMATION:
E I R I M f ct d FOUNDATION TYPE: (Check all that apply for the new
ar y e ease ~ anu a ure ~ construction area) "'.
Permit: Yy Trusses: - Y Mi CRAWLSPACE' 0 POST & BEAM
Lot Split: Sump Pump: _ Y N /[]'I SLAB ,..},_ 0 BASEMENT
Does any part of the property lie within a special Flood designation area: _ Y JSi-~\' T'-~;;~;Y'''~~?~:~ Y _N
, '" I' ~ ".-, ~.;;--'/ i' . " \' ,. --, _ -..
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, r4is p'e'r'mit is vilid" only lfcon'stluction co.mmen'ces
within 180 days of the date of issuance of the building permit, and must be completed (Certificate cif<k~Jpancy issued) withlIi"lS-mO'nthS ohhe
issuance date. Class I structure permits are subject to the General Administrative Rules of the State cfr;r"ndia'na (.l~';915 lAC 12) regardingrexPi~~tion
time frames for beginning and completing constructiOb.!; (I! Mil r - 1 ?nlle- i! l J / I
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a struCtllre, or any change in ~e of hindbr!
structures requested by this application will comply with, and conform to, all applicable laws of the Statepf rndiJn-~and_th~':.?oning Ordinanc,~\~f-,C-.i~el
Indiana -1993" (Z~289) and amendments, adopted under authority of r.c. 36~7 et seq, General Assembly ct:he State oflndiana,ana'all.Acts,ame~dat~ly
thereto. I furt~er certify that only kirchen, bath, and floor drains are connected to the sanitary sewer. I furthe-t'cei'tify~!he construction will ocf be
r occupied until a Certj{jcace of Occupancy has been issued by the Department of Community Services, Carmel, lndtana,_~, ---J
~,~ C, J, (/eS S-:;-oG
Igna re of Owner or Authorized Agent Date
# Charged Re-
Upper Footing Reviews
e
Reviewed/Approved: Dept. of Community Services (Date)
S:Permits/formsjllP RESIDENTIAL