HomeMy WebLinkAbout06100137 Application
C't ifc lIC"'" h' Permit#: tJh/o();::57
t y 0 arme lay -' owns tp
COMMERCIAL/INSTITUTIONAL/MUL TI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings)
FAA:
], 1- f'1I - n 3D
STATE:
cd/ c-rV'L-\" , J JJ 66]
BEST METHOD OF CONTACT:
Ib b LI. ",r-r "] 11- LtCl} - 4'-t1-J
BUILDER
OF
RECORD:
NAME:
151',ke
e<.,+''-...
PROPERTY
OWNER:
BUILDER'S EMAIL ADDRESS:
Ior-.\YJIo I "-kc e.>~L
NAME:
YVh Poet.,
Huc\.t,...r
STREET ADDRESS:
~ L i..... (lV'.
f...,
-5LN
LOCATION
& PROJECT
INFO:
ADDRESS Q.f CON5llqJCTIO.N:
"23 S ..(.....c Ave...
Address of Shell Building: (If different than Address of Construction)
STATE COMMEROAL
DESIGN RELEASE #:
(".~
3:A131-2
PHONE:
'2, I
'})
CITY:
ZIP:
PHONE:
'J. 0.1- rH- JZt 16
FAA:
CITY:
kwo"" C l.fA;r
STATE:
U'r
ZIP;
o~72..
SUITE #: (If Applicable)
~O
Lot # and Subdivision: (If Applicable)
SCOPE(S) OF 0 FDN
RELEASE: )3' ELEC
o STR M' ARCH J;Y MECH
o SPKLR OTHER(S):
WATER UTILIn' /'
PROVIDER: C- C- r ~ ~ \
{r_!" '-"...,t' \
SEWER UTIlITY
PROVIDER:
PLAN COMMISSION I BZA I BPW DOCKET NUMBERS; AND/OR
COUNlY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Floors: J
Elevator or Uft: 0 YES YNO
BLDG. CONSTRUcnON TYPE:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
M COMMEROAL 0 NEW STRUCTURE
(Privately owned hospitals and medical 0 ADDmON
officeS/centers are commercial) 0 Room(s)
o INSTITUTIONAL 0 Porch
o Municipal/Public Bldg 0 Mezzanine or Deck
o School ~ REMODEL
o Church 0 NEW TENANT FINISH
o ~~~~~;~lJ;ASED FOR cO@l~~i~~g~NG
Subject to comp.liance wittDalilmAaltai>:mlRAGE
FOUNDATION TYPE: (Ch~5M!~W'~f1d LccaODoce4\.. TOWER (New)
a~or the ne~~u8'~n~aPf~~i M U [\J rQ, ~\=E~,"\I',q}'l'LR,CO-LOCATE
~ SLAB ClIM :-s ACE 0 DEI'10ltt!t5fP
CITY F LA ~ 1;:1,- / CLAY -+'nWi\lSHIP
o POST&_BEAM _PIERllmIA'-.f.,~MEN lWAlKOUI:_Y_N)
ESTIMATED COST OF CONSTRum
(EXCLUDING LAND VALUE)
()(j{j
V-13'
OCCUPANCY CLASSIFICATION:
,VI
PROJECT INFORMATION:
Earlv Release
Permit: _Y V N
Lot Split: _ Y ..,. N
Manufactured
Trusses:
Sump Pump:
_yVN
_yv N
FLOOD ZONE AREA DESIGNATIONfSl FOR THIS PROPERTY:
PLUMBING CONTRACTOR:
5Gl.,\Jdlr,,-'l1\JL.-.. ~', k:;
Plum;;tcd?a 2ti ~rj"3'6 r
Class I structure permits are subject to the General Administrative Rule~ 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 - 1993" (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 se er. I further certify that the construction will not be used or occupied until a Certificate of Occupancy or Subst:1lntia} Completion bas been
',"uodbytheDopan oICommu' miw,C",md,Ind'an~ . -JC.Ql.\l1Dm1>f)N,AL- ~
Signature of OWner 'zed Agent V Print ~ Date
OFFICEUSEONLY:**************************~********************************************
INSPECTIONS REQUIRED: ~\ 1bFiling Fees: If) 7.1',30 /-'.' ~3 ef:)
Lower Footing I Base Inspections: ~ () () . () V
Cert. of Occupancy: . tJ 0
Upp
Site
TOTAL:
Reviewed/Approve : Dept. of Community Services
S:Permlts/Forms{ILP co MEROAL
0'* ,IZ,2.00(,
(Date)
1//38;;, . 3 ()
Date