HomeMy WebLinkAbout06110066 Application
\qty ofConndlGay Towmhip PffmU ()(,I / OOf"l"
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, 8< Two Family: New Structures, Additions, Remodels, 8< Accessory Str~ctures
NAME ;;;ft<.I'J
6UILDER of
RECORD:
PROPERTY
OWNER:
FAX
58;)- ()lf53
ZIP
4(d)3J.....
STATE
~:v
BEST METHOD OF CONTACT:
~-85/cL
PHONE
FAX
CITY
STATE
ZIP
SEWER UTILITY
PROVIDER:
('
ADDRESS OF .CONSTRUCl1~ /1 ~ J
00 I' IUR >JJ. UAc/e
WATER UTIL /) _ _
PROVIDER: ~
LOCATION
8< PROJECT
INFO:
LOT #
SUBDIVISION NAME
N CONTRACTOR; PLAN COMMISSION / aZA I BPW DOCKET
D/OR COUNTY WELL AND/OR SEPTIC PERMIT #'5 (IF APPLICABLE):
o
. ~ ~ W~~PROVEMENT:
. . EWiSTRUCTURE
d ROOM ADDmON(S)
aliK4 ~6 PqR~H ADDmON(S)
. U R ~ODEL
o A CESSORY BUILDING
o ACHED GARAGE
n ATIACHED GARAGE
o D"EMOLmON
,
o
PROJECT INFORMATION:
Early Release VI
Permit: _ Y --LN
Lot Split: _Y +N
Does any part of the prope
ZONING:
-/
SQUARE -:2 'I If
FOOTAGE: U U Ol 7
ESITMATEDCOSTOFCONSTRUCTlON: 12.:3,000
(EXCLUOlNG LANO VALUE) ex J
/Y7e,e;;-)J- iF Of:, 1/ (Job5
PLUMBING CONTRACTOR: J 17
L /) m f'r IDlUYJ/CcJ/
Plumber's J\'Jliana State License #:
~ 81n (0 L/SLt'{)
Which plumbing codes will be applied to the construction:
filPlntemational Residential Code wI Indiana Am~ndments
b Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Construction Code)
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o
~
POST & BEAM
BASEMENT
WALKOUT:_vRN
o CRAWLSPACE
o SLAB
d~signation area: _Y
* *************************** "**'l*~*l*************
Filing Fees: 7?-.-' J'()
Base Inspections: -2 -1'1 30 # Charged Re-
z; . _ J _.........../} Reviews
Cert. of Occupancy: ~ ..:> - J v
pjU.F.: /';2 (,! {I' 0
{~~/~7l'~/3. -0J
Fee Received by: "
".-:
N
Date
Additional Fees