HomeMy WebLinkAbout07020011 Application
BUILDING, PROJECf, OR TENANT NAME:AJ d 1 /1.. 1/
rv'e)i'al1 1'14, Uti/II I
SCOPE(S) OF "FON 0 STR
RELEASE: 0 ELEC 0 SPKLR
PLAN COMMISSION 1 BZA 1 BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If AppHcable):
TYPE OF CONSTRUCTION: TY: OF IMPROVEMENT: PROJECT INFORMATION:
o COMMERCIAL NEW STRUCTURE Early Release Manufactured
(Privately owned hospitals and medical 0 ADDmON U~ _y LN Trusses:
officeslcenters are commerdal) RELEASEID ::=R06iiks).:ONSTR "',' . I
o INSTITUTIONAL . q Porch,CP with ;~Il re,t9t.~itS _Y_N
o Municipal/Public Bidg Subject to 'OrnM';iianin~.orDeck~(\C'
o School 0 CREMODEL" ".' LC "':' '~~':r:'l'L900.z"NE AREA DESIGNATIONfS\ FOR THIS PROPERTY:
/ 0 Church DEfCl1 CNEw-"TEr-iArff,Fi~isH y ::,.:"~:-'-' 10' J d
ill Mum.FAMILY /6 (:)F~~E5?PIJ.YIBl!IIf9!.f:!G,Y TCWN;:,H,,\ ---lA. n::\ h CCAe
Number of units: _ CITY ~ DEfA'CHrn"GARAGE
. 0 ATTAcHalit!GA.RAGEA PLUMBING CONTRACTOR:
FOUNDATION TYPE: (Chec~ all whIch 0 CELL TOWER (New) 0 ' I'.
apply/or the new constructIon area) 0 CELL TOWER CO'LOCATE CJcJ 17'4
& SLAB 0 CRAWL SPACE 0 DEMOLmON Plumber's Indiana sJte License #:
o P05T&_BEAM _PIER 0 BASEMENT (WALKOUT:_Y_N) PC 10()(J00J50o;
Class I structure permits are subject to the Genera] Administrative Rules of the State of Indiana (See 675 lAC 12) regarding expiration time frames for beginning and
_sompleting construClioll.
I, tbe undersigned, agree that any construction, reconstructio!1,eruargement, reloc_ation, 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 applicalSle laws of the State of Indiana, and the "Zoning Ordinance of Cannel Indiana - I993~ (Z- 289) and amendments,
adopted under authority oE I.c. 36-7 et seq, General AssemEly 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 funher certify that the construction will not be used or occupied until a Certificate of Occupancy or Subst;mtial Completion has been
issued b he Depart ent 0 mmuniry Services, ohmel, Indiana. 1
,.! . "1/1 #-$'&fiI 11. #Nttftlf1f1
Signature of Owner or Auth rized Agent \ I J Print /
, /
OFFICE USE ONLY: * ** * ** * ** * ** * ** * * ** ** ~.,~ * * ** ** ** * * **** * ** * 2l **** * *** * * ** ** * ** ** **** ** *
cnONS REQUIRED: ~\' / Filing Fees: fRlR ,. DO /?
, . Lower Foo . 9 Under Slab ./ Base Inspections: f..o 00. () 0 ~ 0 Jl..6 J.J
Cert, of Occupancy: ~5(', 00 1fOV r~' '
TOTAC~W~
Fee Receive by:
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
STATE COMMERCIAL
DESIGN RELEASE #:
WATER UTlUTY
PROVIDER:
# of Floors:
. IIC" . Permit #: 6 70 ::(OOl I
tty of Car me .ay Townshtp I
COMMERCIAL/INSTITUTIONAL/MULTI-F AMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings)
NAME:
-tJwt'-rJ R~ bevel
PHONE:
CO. L L C
FAX:
"2.<::\7-7142
1.C!7-7;>ObO
STREET ADDRESS:
lqo\ Ct-&(W rd,?v'r1le Road
CITY:
STATE:
4b 2.14-
ZIP:
lV)dl'a~ 011':7
IN
BUILDER'S EMAIl ADDRESS:
";>\-ev-e _ (.., OY' I"v\<:l ~ '^
NAME:
t1.::tvWt' a4 l!t~dVe
BEST METHOD OF CONTACT:
. CO'l'l
WOI1~
ed wttVd YO'7f; 0.
PH NE:
FAX:
STREET ADDRESS:
CITY:
ZIP:
STATE:
ADDRESS OF CONSTRUCTION: /1C-17
SUITE #: (If Applicable)
I
OM-fI1F
~2Ih8.?
(;ar/YI-cl
o ARCH
OTHER(S):
o MECH
;Q,10g
o PLUM
SQUARE
FOOTAGE:
ESTIMATED COST OF CONSTRUCTION: -I/.
(EXCLUDING LAND VALUE) 11 100, 000
~
.J{ 3S"O~. 0
R.-1..
SEWER UTlUTY
PROVIDER:
UirlJ1t'/
7CJ 7.<X) /1
51?
?
Elevator or Uft: Q YES
Sump Pump:
j Y N
-Y IIN
1-/;/07
Date' '
52.001
(Date)
Reviewed/ pproved: ept. of Community Services
S:Pennits/FormS/ILP COMMERQAL
Date