HomeMy WebLinkAbout06110040 Application
~\ City-ofiG~~~ilC/ay Township Permit #()b II bOtfD
\ . ! /REsThENTrn IMPROVEMENT LOCATION PERMIT APPLICATION
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.., "!:QJl"~(:,~,<~_~Fcir Single Fa~iIY'~~e,n,~ome, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILl)ER S/A EY )
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RECO'RO: STREIT ADDR~SS/
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PROPERTY
OWNER:
"
BUILDER'S EMAIL ADDRESS:
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f3.(OLIc
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STREET ADDRESS:
/4U. ( 4A0~V--
LOT#j 15
NAMEAJ "G'"
LOCATION
& PROJECT
INFO:
ood:1
Or
SU~DIVISION NAME: d I
. &c1 Ie.
A.'
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PHONE:
"3 \7 .7 c;(; . i 01 :z.
FAX:
ZIP:
STATE:
+1
07(1
BEST METHOD OF CONTACT:
'3 \ 1 . q I ') . <:IS lj ~
PHONE: FAX:
311, 70(.( 077--
CITY:
/,J",
STATE:
IN
:<tJ
(!.-re.el<-
SECTION:
740
~ ,7
SEWER UTIL WATER UTIL.IT:Y-7 ?I
PROVIDER: (( PROVIDER/{!:JJVt~l:::.
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NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNlY WELL AND/OR SEPTIC PERMIT #.s (IF APPUCABLE):
FLOOD ZONE AREA DESIGNATION(S)
FOR THIS PROPERTY:
TYPE OF CONSTRU
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
time:
1M RESIDENTIAL (For
Additions. Remodels. Etc.)
ON:
PROJECT INFORMATION:
X(ur1~haded)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
o ROOM ADDITION(S)
o PORCH ADDmON(S)
o DECK ADDITION(S)
rzf REMODEL
iDw ,/ Basement Finish only
o ACCESSORY BUILDING
o DETACHED GARAGE
o ATTACHED GARAGE
o DEMOLITION
\.~
Early Release
Permit:
Lot Split:
c____/ Manufactured
Y N Trusses:
y ~-----S~~p Pump:
_Y_N
_Y ---+-.N/
ESTIMATED C02T OF ~()Ns;I:RLJ01I)N'
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TAX MAP PARCEL #:
I
PLUMBING CONTRACTOR: /
o
~o OWl
. - /, \
I ()'W'J
J ,.
Plumber's Indiana State License #:
Which plumbing codes will be applied to the construction:
o International Residential Code w/Indiana Amendments
o Uniform Plumbing Code wI Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
o CRAWLSPACE 0 POST & BEAM PIER
o SLAB 121 BASEMENT (WALKOLlT:_Y~)
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this pennit is valid only:if construction commences within 180
days of the date of issuance of the building pennit, and must be completed (Certificate of Occupancy issued) within 18 months of the issuance date. dass I
structure pennits are subject to the General Administtati~e UI~e State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
~ leting construction.
I, the undersigned, agree that ~ constru iO~~ ' c. . ent, r~location, or alteration of a structure, or any change in the use of land or structures
request by thl applica . n.~iJYco ... 0, II applicable laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana -1993" (Z'
289) d entbnen, ad te .. 6,7 et seq, General Assembly of the State of Indiana, and all Acts amendatory thereto. I further certify that only
kitc en, t/And floor' / 0 the sanitary sewer. I Curthercertify that the construction will not be used or occupied until a Certificateo!
Dc up c theeni <:-p'-'tmentofconuuUnitYService'lJ~,:diana 3/a:...b IIIr /61(
Signature of Owner or Authorized Agent Print Date I
OFFICEUSEONLY:*****************************************************7~************************
INSPECTIONS REQUIRED: Fiiing Fees: _ . 5 SO
, . Base Inspections: !.. I l f 0
Upper Footing Lower Footing Under Slab -' 3. ;> {/
.~ ~.. . Cert, of Occupancy: .5
C Rough~ Meter Base Final Si
_ P,R,LF,; Additional Fees
\, k;~ IH7"v / /,/tQ;.Al:,; /9 ;d v2y?O(J
Reviewed/Appro ed: Dept. of Community Services (Date) ~~/V ~:6,,--
S:Permlts/forms!IlP RESIDENTIAL Fee Received by: /
# Charged Re-
ReVIews
~
Date