HomeMy WebLinkAbout03100070 Application
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Application for !l03 'Q/lO 17?
1 L. P' Date
Hold #: mprovement ocatlOn ermlt Roll File I
This penmt IS valid only If construction IS started wlthm 180 Jays of the date of Issuance for reSIdential const CllOn, and for commerclal proJects, wlthm one (1)
ear of the date of issuance of the State Commercial Desi n Release. All construction must be com Icted (c/o issued within 2 ears of the issuance date.
~~~cC~ay
Township
BUILDER
If
BREET JI/b'8/Y)
STATE 11 /
~ ON.
/
OWNER
YIorus ~ JlJ/7U {l,b aJxvu
CITY
LOCATION
SECTION
:u
..w. 1j/;;{)g!L
Signature wner or Authorized Agent
~~"ii ?jcJ CE
(Print)
;~q~ c
A. TYPE OF CONSTRUCTION
1. ~ Single Family
2. 0 Two Family
3. 0 Multi-Family Type of Foundation
4. 0 Commercial/Industrial 0 Crawlspace
5. 0 OTHER ta.. Basement
(Specify) b' Slab
B. SEWER: /} /I
1. lI( Public (Name of system! 'fOIl
2. D Private (County permit # ') G. Lot Split YES NO I
C. WATER: /J H. Flood Zones YES ------:- NO----'-j-
1. }At Public (Name of system (If)), IJ I L) 1. Sump Pump ~ES' NO
2. 0 Private (County permit # ) .\ n \~ IlolL, J Manufactured Tru~en': S -, NO .
D. ZONING:S!' '(!Nfj ~\.OK. PlumbingContraclor ~_I.J
E. ESTIMATED COST OF SPNSTRUCTION IRC Plumbing Code: 0 . Plumber's ", /1/V1 r
(Excludmg Land Value) 'lP /.6 U;, 0 1:J. Indiana Plumbing Code: jQ License #: / O~ 7
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I, the undersigned, agree that any constructIOn, reconstructIOn, enlargement, relocation, or altcr8i.sbJU8"RjC(N)mi)ff~hpRf;f~mUG.BBNuctures
requested by thIs appllcatlOn will comply with, and conform to, all appl1cable laws of the State ofIndlana, <\5; ~r~r.gniiigP'fdl?r~e%tf<ReguItl:t-'1993"
(2-289) and amendments, adopted under authonty of I.C 36-7 et seq, General Assembly of thE~ }Ij4iJi~, fnlf\l1il ~~ thereto 1 further
certIfy that only kitchen, bath, and floor draIns are connected to the sanitary sewer I further ~ hlt t"'e'CoItsQAfMYOf"lllJeS'@Rvrcl!;~ until a
Certificate of :;upancy has been issued by the Department of Community Services, eM I, I,Q;!fuCARMEL I CLAy TOWN
INSPEC OED: SHIP
$nde:. Slab . Rough:II1'
: Site Fin
,
Do plans in~de a porch?
o Yes~ No
F.
TYP~.OFIMPROVEMENT
1. ~ New Structure
2. 0 Addition: Porch Room
3. 0 Remodel 0 Commercial Tenant Space
4. 0 Foundation Only
5. 0 Demolition
6. 0 Accessory Building
7. 0 Garage Detached
Attached
9/)-- J..2-<-'"
(Phone Number)
Filing Fees:
Base Inspections:
Cer\. of Occupancy: ~;}. 0 0
. "11 (jU
P.R.I.F.. Jd .
TOTAL: ffiiiiJ t / ~ 9 t-;
~. ~.~:b.~ ,./~
Fet,Recelv 'by ~ S:Pennils/FomlsIlLP5-02
E-Mail:
5' 1-(/" '> I.. "'.....@ (:' ~--i-4; fi,."., .> . c.,,..,
ocket #'s; T AC Date(s)
Dep\. of Community Services
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