HomeMy WebLinkAbout06080044 Application
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City of Cannell Clay Township \Y Permit #: O~ 0 ~ 00 L( L(
RESIDENTIAL IMPROVEMENT LOCA ION PERMIT APPLICATION
For Single Family, Multi-Family, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Structures
BUILDER of
RECORD:
NAME
t>
STREET ADDRESS
bll.'IVE S. . -- .
,
CITY
l' .
STATE
I
ZIP
BUILDER'S EMAIL ADDRESS
BEST METHOD OF CONTAcr:
PROPERTY
OWNER:
PHONE
FAX
Mb'
STATE
.s I
SECl1DN
- 3if?
4'7- .
LOCATION
8< PROJECT
INFO:
SQUARE
FOOTAGE:
SEWER UTILITY WATER UTILITY
PROVIDER: C Ti PROVIDER:
NAME OF UTILITY EXCAVATION CONTRAcroR;.p4N COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR coUNtY mtL:' D/OR SEPTIC PERMIT #'S (IF APPUCABLE): . \ G
""/. (&/ \ \ - N
TYPE OF CONST R.~CTI .,~..~;~i \:r~ . TRACTOR:
rd' SINGLEFAMILY,~o' ~ -- L S- ",'ra If'S . -H
o TgWN;f!OM!;!I,/ 'f)l~ . ~~~~ ,. ~r~Stat; Lr~~se #:
o TWO:FAMILY '\ ,~ .9 <n
#Of~r\its: ... IVII ~ ~ j
o MULTI'~~~ILY~ W~!ll~Willbe'PPlledtotheconstructlon:
# of Units:. .<:'" c_O
......atiqpilUfe.idential Code w IIndiana Amendments
o RESlD!;~-r~ 0 ~ _
Additions,'Remodels, 0 ;lIIInn ~.QIing Code w/Indiana Amendments
\ tli9-Farr!lt ~struction COde)
P OJECT IN ON: ,
~ ./: FOUNDATION TYPE: (Check all that apply for the new
Early Release / Manufactured construction area)
Permit: Y ~ Trusses: ~Y N
o CRAWLSPACE
Lot Split: _Y _N Sump Pump: _Y _N 0 SLAB /
Does any part of the property lie within a spedal Flood designation area: _ Y -.J{N
o A'QST & BEAM
0' BASEMENT ./
WALKOUT:_Y~N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the building permit, and must be completed (Certificate of Occupancy issued) within 18 months of the
issuance date. Class I structure permits are subject to the General Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration
time frames 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 use of land or
structures requested by this application will comply with, and conform to, all applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel
Indiana -1993n (Z; 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
us d or occupied u~til a Certificate of OccuI?aDcy has been issued by the Department of Community Services, Carmel, Indiana.
. LOR; A..A:l>.b5Mlc'- HEN/;Ne. '3 hJDIo
Signature of Owner or AUthori~ Agent Print Date
OFFICE USE ONLY: ***~*********************************************************************
Filing Fees: /0 if J 0
NSPE .EQUIRED: . ,-, /0 Ch d R
Base Inspections: .;2 '7 /. " # arge e-
Reviews
Cert. of Occupancy: S 3 . 'Fa
P R I F . / ()l. r; I O(J Additional Fees
('-1~~JfC4 10 J'
Fee Receiv by:
Reviewed/Approved: Dept. of Community Services
S:Permlts/FormS/ILP RESIDENTIAl
(Date)