HomeMy WebLinkAbout06120063 Application
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City of Cannell Clay Township Permit #: V (a (2. ()D{gS
COl\1MERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
,
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings
BUILDER of
RECORD:
NAME C PHONE
CCllLLoLJr;?j ON5JRVG71prJ CD.T-iJG,
STREET ADDRESS
3'J~g "J,.IO!JSV/l..J...l RD.
PROPERTY
OWNER:
BUILDER'S EMAIL ADDRESS
&l.tve@/I\oc.vJlaU /'cons-rruC+IOh, CO",
NAME
U1ERS r()~l.f
b03JRESt 8" ~
PHONE
570-
LOCATION
&. PROJECT
INFO:
BUILDING, PROJECT, OR TENANT NAMES PE. c, Sp AGE
STATE COMMEROAL SCOPE(S) OF 0 FDN 0 STR 0 ARCH
DESIGN RELEASE #: RELEASE: 0 ELEC 0 SPKLR OTHER(S):
WATER LmLTIY /'
PROVIDER: l...--
cTRW
V..eJL
SEWER LmLTIY
PROVIDER:
FAX
7J..- 733 ~?J.. -471/-;;'
.=rJATE 'l-b;). 6 f
BEST METHOD OF CONTACT:
31J.s-
FAX
ODD
:JJJATE
570- D
L/l:J.s t
SUITE # (If Applicable)
S
Lot # and SubdMslon (If Applicable)
-3
TAX MAP PARCEL #:
o MECH 0 PLUM
SQUARE
FOOTAGE:
I)~oo
36 ~b'3. b 0
ESI1MATEO COST OF CONSTRUCTION.
(EXCLUDING LAND VALUE)
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'S (If Applicable):
# of Floors:
Elevator or lift: [) YES Q NO
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
..Qlt COMMERCIAL 0 NEW Sl]<.!,lC.ll.lllf
(Privately owned hosp~als ...GJ1 ~1l1fON \ u 1'1
andmedlcalofflces/~'l~O FOR C;L" ~,:,q;QI!li1Pl(51f\S
arecommer~L\:.Atlt.:. " ,ce v":lth o\q/>orch
o INSTITUTlON e>:t to camP\I"f '-031 Ccg)SM~anl"".or Deck
o MumCl ~bhc ~lp!1;ta~e 8nd LObrREMOllEb!\\~;l:"."
o School 'cOMMUjl(j NeW.TE%fll~
o ChurchDEPl OF ~. ,Et I O,..iA[Cess'diN BUILDING
FOUNDATION TYPE: ~f1l@feir\'" ~,Q, />pETACHED GARAGE
a~PIY orthenewcci~~Onarea). INOllb' AlTACHEDGARAGE
LAB 0 CRAWL SPACE 0 CELL TOWER (New)
ST & BEAM 0 BASEMENT 0 CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEMOLITION
PROJECT INFORMATION:
Ear1y Release V1 Manufactured ~
Permit: _Y -I:Y..N Trusses: Y N
Lot Split: _y)(2N Sump Pump: _Y N
Does any part of the property lie within a special Flood .I
designation area: _Y j{N )( - UAlLShotAe4...
PLUMBING CONTRACTOR:
GORDDN PLV/'flBI N ~
Plumber's Indiana State License #:
"If lobtf3b.
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 confann 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 sewer. I further certify that the construction will not be used or occupied until a Certificate of
cy or Substantial Completion has been issued by the Department of Community Services, Cannel, Indiana.
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Signature of OWner or Authorized Agent
_DAV f. j1I)Cc, ULLo(} 61t
Print
IJ.J/5/0b
Date I I
OFFICEUSEONLY:************************************************************************
INSPECTIONS REQUIRED: Filing Fees: ?v5'. 00
. # Charged Re-
Upper g Lower Footing Base Inspections: Reviews
Cert. of Occupancy:
TOT~~
Fee Received by:
Reviewed/Ap roved: D pt. of Community SelVices
S:Permlts/FormS/ COMMERCIAL
:J.o,'J..O~
(Date)
Additional Fees