HomeMy WebLinkAbout07020090 Application
SEWER UTILITY C- I "'-
PROVIDER:
'.'ij>''''''>'"'
( ,', ~ ....u\
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BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
&. PROJECT
INFO:
-.." ..1 /1AJIJ/III/ Cfpt Jo1ftlsltip Permit #tJ'l tJZOOGJD
RESIDENTIAL IMPKOYBhffi~T LOCATION PERMIT APPLICATION
For Single Family, Town Home, &. Two Family: New Structures, Additions, Rem,,"'''''', &. Accessory Structures
NAME: G.G?D\M'Yl ,4-s-;,ec.i A-ilD I~. PHONE Bf3'@-Sb<2? I
r;q~~DR~. <>l\1I"~ VA-u..ei 00. ~wreD
B!l!US.E~'S EMArl ADDRESS: '
r'Hi L . 6e'lT\..4 I"I'l e. GtmAM, CO""
~IE~t_JCltl2~Lii,v,J t9()~FR.'l
STATE:
IN
FAX:
~~ST3L{
ZIP:
4~ \Lj2
BEST METHOD OF CONTACT:
E;-MJ\\L PHar-n1
FAX:
PHONE:
STATE:
IJ
ZIP:
46032-
ZONING: S I ,~
LOT#:
SECTION:
SQUARE
FOOTAGE:
ADDRESS OF CONSTRUCTION:
SAM~
~j...
,
WATER UTILITY
PROVIDER: C-t
ESTIMATED COST OF CONSTRUcnO
(EXCLUDING lAND VALUE) \ lOD IL-
NAME OF UTIllTY EXCAVATION CO RAcrOR; PLAN COMMISSION I BZA I BPW DOCKET
NUMBERS; TAC DATE(S); ANDIOR COUNTY WEll ANDIOR SEPTIC PERMIT #'5 (IF APPUCABLE):
v LUUI
FLOOD ZONE AREA DESIGNATI
FOR THIS PROPERTY:
TYPE OF CONST
o SINGLE FAMILY
o TOWN HOME
o TWO FAMILY
# of units being
constructed at this
~. RE~~e~NTIAL (For
Additions. Remodels. Etc.)
TYPE OF IMPROVEMENT:
o NEW STRUCTURE
!~ ROOM ADDITION(S)
PORCH ADDmON(S)
DECK ADDmON(S)
REMODEL Which plumbing codes will be applied to the construction:
_ Basement Finish only ~
o ACCESSORY BUILDING International Residential Code w/Indiana Amendments
o DETACHED GARAGE ~
o ATTACHED GARAGE 0 Uniform Plumbing Code w/India~Q\~;~~~nts .
PROJECT INFORMATION: 0 DEMOUTION FOUNDATION TYPE: \~Q~tr'~91pi>'Y for the new
Early Release ~ Manufactured /' construction area) CO~ '(\ ~~i~;. ~~: F
Permit: _Y _N Tr"S5es: yY ~ _____ ~ rD"'~w;~I\~p::.Qsb~; ,G ~_PIER
Lot Split: _Y~~mpPump: ~ ~~;~~~ :v\. :_Y-/!-N)
For Single Family and Two Family dwellings, additions, remodels, and/or accessory stru~~ is .~. ~a\' I}\i struction comm~.~ce 'O(\.tl....
days of the date of issuance of the building pennit, and must be completed (Certificate oT5ccu~c~M . I~.IJ\.~ of the issuano.~'
structure pennits are subject to the General Administrative Rules of the State of Indiana (See ~\1i\cn'H-l . IUt.dnV:i'hon time fr~ itrtg and
completing construction. 'O~ ('\~ \.J \\"....
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or altera~ ~ructure, or any change in . ,a . '" structures
requested by this application will comply with, and conform to, all applicable laws of the State of W):n~, and the ~Zoning Ordina ndian.a - 1993~ (Z~
289) and amendments, adopt under authority of J.e. 36~7 et seq, General Assembly of the State of Indiana, and all Acts ame J further certify that only
ki ,th, and floor d re connected to the sanitary sewer. I further certify that the construction will not be ed until a CertiliCJJ.te of
"pancy r{iSS e theDepartmentofconunUnityse~7~:npan~. 6ehuM )-1"-07
SJgnature of Owner eN' Authorized Agent Print Date
OFFICE USE ONLY: ****** *** ****** ** ****** ****** *~~* *****.****** *******~**;;*'*****1Y'**************** *
INSPECTIONS REQUIRED: Filing Fees. ;J # 'Lr--
B I ct" /6 '( .)0 # Charged Re-
~er ~ Lower Footing Under Slab ase nspe Ions: 's - ~ ReViews
~ ~ . _ -,' e~ Cert. of Occupancy: 3..) 0
~ Meter Base nalS.te
P.R.I.F.: Additional Fees
,
c
X (Wl~ed
TAX MAP PARCEL #:
PLUMBING CONTRACTOR:
_I'v\0j2::100 ~L.,^~-e irJ G
Plumber's Indiana State License #:
.'1,07
(Date)
S:Permits,lForms{IlP RESIDENTIAL