HomeMy WebLinkAbout06070162 Application
Township
This application form is used for all residential and
commercial projects.
Improvement Location Permit
This permit is valid only if construction is started within 180 days of the date of issuance [or residential construction; and for commercial project..,
within one (1) year of the date. of issuance of the State Commercial Design Release, All construction must be completed (c/o issued) within 2 years of
the issuance date.
Permit No.
Date
O(porJOI &'2.
LannclILlay
Hold#:
BUILDER
NAME PHONE
.5TL C.o~AC.TINl:l (11) 840-.5,40
FAX
STREET
CITY
STATE
ZIP
OWNER
IN 181
1f1
"6-
TENANT NAME
(If a Iicable)
~"-s ~t:sret<0
NAME
PHONE
WLS ~AL E'SfmE atlt:m..,~ w:.
0::3
STREET
CITY
STATE
q,SS JZ.I\,vDALL 1>R.
'NOl A.rJ~ POL-l S
IN
ZIP
4bz~o
~.,-
'576;'\ I
it 109
WCATION
LOT SUBDIVISION
qu'tb- 5
SECTION
ADDRESS OF CONSTRUCTION
(n~ Ul'ltlALL t)~.
1~\)'AIII^,)oLIS ItJ
A. TYPEOFCONSfRUCTION Doplansincludeaporch? F. . TYPE OF IMPROVEMENT
1. 0 Single Family 0 Yes 0 No 1.. 0 New Structure
2. 0 Two Family ~ 2. 0 Addition: Porch_Room_
3. 0 Multi-Family TypeofFoundalio'bC"i\O S 3. 0 Remodel III commercia~]e ace
4. . Commercialllndustrial 0 Cr:.\-,,<~W "0\'iJ.\\0<:'> 4. 0 Foundation Only
5. 0 OrnER , .R. ~ijl~'!l" 1(\\;. ,~D Demolition
(Specify) . . ~\) -;:~~d!lll\\\~ \ Gooe:Q.~\C\:;:: \1;.' 0 Accessory Building .
B. SEWER: ~'5 ((1\>\\;> 6 ,,-oca: '\'l S\:..' ,;-N"",,S'f: 0 Garage Detached _ Attached .
I. . Public (Nameo~!R;' ,0 C~a:\e a:\\ "1>~-\\ :-( '10
2. 0 Private(County~W# o\'5'CO""'\~')C~ G. Lot Split YES N01-
C. WATER: :\ O'r ~'C.\-I ~p.. H FIoodZon.. YES _ NO-X....-
1. . Public (Nameofs~ ~ Cp..?\ ~~\f': I. Sump Pump YES NO_
2. 0 Private (County pe~ e ) J. Manufactured Trusses YES NO
D. ZONING: - K. Plumhing Contractor j<:i;VIIJ 1>IXDN
E. ESTIMATED COST OF CR.NSfRUCTION
(Excluding Land Value) ~ IOO,oco
me Plumbing Code: 0 _llumber's
Indiana Plumbing Code: y- License #: 'f'(. I OOOO!:, II
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 a 'eablClawso tate of-Indiana, and the "Zooing OrdinanceofCannellndiana-l993"
(Z-289) and amendments, adopted under authority of I.C, 36-7 seq, General Assembly of State of Indiana, and all Acts amendatory thereto. I further
certify that only kjtchen, bath, and floor drains are connect to the sanitary sewer. I further cer that the construction will not be used or occupied until
a.cet1iJicaJe o/O"!:up,,/ ~ .ssued by the Depar ent O;:Jonunnnily Services, Carm ,Indiana,
-:&~ ' (/ INSPECITONS D:
Si luro of Owner or A orized A '3 I mgiUnder Slab Rougb-~-Mefer Base
~~l2t-1/!t/ #& ff/- 75-Z$ Site Final l~
~ 1/ d. / 'phoneNumbor) 'SqF;._ AGOO
/t?/71 raA1~r ?-i//~ Filing Fees: h ;: :>, {?(jl
E-Mail: 7Vl.YJti"VClfIV~-~.Ct9u{InspeCtiOnFees:.:.)()O.CO ""
/ 0 12 tJO Qf;r.'
Plan CommissionIBZAI Do ket #'s; T AC Date(s)
Cer!.ofOccupancy:
'/ \ ~:;~: ;/i-; :.;,
SAJI- C '''30\- -W f>(~ "-8$~ l-kr5:lcQ,\ Roll t1 .:h -I! a ZfJ~;. ~
IfJ r~,.w""',_ . - J:ti:t.,,- ~, Ir".
;j~~