HomeMy WebLinkAbout06050164 Application
City of CaNnell Gay Township Permit #: f)~()6'O (LIt
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
NAME
)IG.,JATv'zf Cot-lSTRv [TrQv
STREET ADDRESS
1'-0 ::,r<\ AvE SL
BUILDER'S EMAIL ADDRESS
,jC1..S0f\.sQ ri2c\ur-~(\t..+
NAME
f'EDCo( COfY\fAA! IE5
STREET ADDRESS .
'nll rc^
i.-J
ADDRESS OF CONSTRUCI10N
ICj [A~T
~kLM tL
Address of Shell Building (If different than Address of Construction)
f'rIklAJ 5-;{1.cE!
BUILDING, PROJECf, OR TENANT NAME:
STATE COMMERQAL
DESIGN RElEASE #:
'" 'i '1
SCOPE(S) OF 0 FDN 0 STR " ARCH '" MECH Q PLUM
RELEASE: Q ELEC IS'l SPKLR OTHER(S):
SQUARE
FOOTAGE:
WATER UTlLI1Y
PROVIDER:
(AfJy\ EL.-
SEWER UTlLI1Y
PROVIDER:
CA{Z(I\ E L-.
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors:
3
Elevator or Lift: c;J YES
~ NO
BLDG. CONSTRUCI10N TYPE:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
III COMMERBAt.LEASED FOR CON$JR~~RE
(Plivat<8I9!Wr!1:~. i\'!l5mpliance with IflIL.rAARmRJ'hs
and medlcal6ffiCi <;enters ' . "''"''D.......Room(S)
are commerdal) iT ~tate and Local CodesO Porch
o IN~/IlT OF COMMUNITY SEl;I'iillOieSmine or Deck
o ~"CYF"~A~EL / CLAW~FINISH
o Church INDIANA 0 ACCESSORY BUILDING
FOUNDATION TYPE: (Check all which 0 DETACHED GARAGE
apply for the new construction area) 0 ATTACHED GARAGE
I!!!J SLAB 0 CRAWL SPACE 0 CELL,TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL,.TOWER CO-LOCATE
(or POST & PIER) WALKOLrr:_Y_N 0 DEMOUTlON
PHONE
]/)- 11-03(,0
CITY
CIt/J'll [ L
FAX
31')- H)-OJ G, J...
STATE
0I--l-,J4
ZIP
4 Loo S
BEST METHOD OF CONTACT:
3r)-<i4~- ')'\1:)
PHONE
FAX
31/- .}.
o
c
STATE
;.) DlkNIt-
ZIP
TAX MAP PARCEL #:
ESTIMATED COST OF CONSTRUCI101'!.
(EXCLUDING LAND VALUE) .0-
"2.J CPO ( r
n P F .If I'> OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
fr1 ,13
Early Release
Permit: _ Y ----L-N
Manufactured
Trusses:
_Y~N
Lot Split: _Y -,,-N Sump Pump: _Y-,,-N
Does any part of the property lie within a special Flood
designation area: _Y LN
PLUMBING CONTRACTOR:
"'.:
ExCFi
mE( I-UAI;( A L
:,:,~~.~~:~~,~~
Plumber's Indiana State License #:
-: "-.....
", ~
"
'.
"
{s>
,~
Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expira~ ~e frarites 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 us~ land ~r structures
requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordin~~e of a.Qrlel Indiana - 1993" (2;
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
Occupancy or Substantial CompJe . n has been issued by the Department of Community Services, Cannel, Indiana.
J"l.,;J
Print
/
*****~~~** ********:***~********'~****************
?.0 ( 't~ .. 9 Fees: . 75(,. 'if
7'/ _ ') CJ 0 00 # Charged Re-
Base Inspections: ex. ReViews
Ct\ t\. Cert. of Occupancy: I () 1- 0 0
o
OFFICE USE ONLY: *********
INSPECTIONS REQUIRE
Upper Footing Lower Footing Under Slab
Rough In Meter Base L9 Site
I
TOTAL:
pproved: Dept. of Community Services
sllLP COMMERCIAL
Fee Rec
:>h3/0&
Date.
.vG fit.