HomeMy WebLinkAbout04020078 Application
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Application for
Improvement Location Permit
0'10 ;t.()-O 'it "
Permit NO.-8'f7J~
Date r:2 - i..2.- of
Roll File
Hold#:
This permit is valid only if construction is started within 180 days of the date of issuance for residential construction; and for commercial projects, within one (1)
ear of the date of issuance of the State Commercial Desi Release. All construction must be com leted c/o issued) within 2 ears of the issuance date.
NAME
PHONE
5'1S-J
FAX
95-7'7'1J-
BUILDER
CITY
STATE
ZIP
TENANT NAME
(If a Iicable)
PHONE
FAX
OWNER
STREET
Su'~
CITY
STATE
ZIP
LOT
us.
S~IONd I~ trc~
/
LOCATION
,
I -v-e-
A. T~' F CONSTRUCTION Do i'&ns inclnde a porch? T1 OF IMPROVE ENT
1. Single Family /!5l Yes 0 No' 1. New Structure
2 0 Two Family 2. Addition: Porch_Room_
3. 0 Multi-Family Type of Foundation 3. 0 Remodel r .q(;?mmer:cia(-TeI!!'nt~pace
4. 0 Commercial/Industrial 0 Crawlspace 4. 0 Foundation Only' ., ., .j. ". . ...,' i
5. 0 OTHER )Q Basement '-%t ! J 5. 0 Demolition . FEB 1 1 2004
(Specify) 0 Slab, hO l.010ltf-fi. 0 Accessory BUIldmg
B. SE1R: ~ J 7. 0 Garage Detached Attached
"1 DIM' !UY:___ J
1. Public (Nameofsysteml C1A-f' n"1. - -
2. Private (County permit # ) Lot Split YES NO ~
C. W A.,Tl'R: , ' Flood Zones YES NO v-
I. J!!l. Public (Nameofsyste~fr Sump Pump YES ~ NO
2. 0 Private (County permit # ) Manufactured Trusses YES ~ NO_
D. WNING: 5-2-- K. Plumbing ContractorJ\ClI'YI.rY\ ,,-SoV)5 ::tVlc......-
E. ESTIMATED COST OF SPNSTRUCTION IRC Plnmbing Code: D.. Plumber's
(Excluding Land Value) "(j) / /..-fa I 0/3 Indiana Plumbing Code: ,KI License #:cpu;aJO!O J
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I, the undersigned, agree that any construction, reconstruction. enlargement, relocation, or <W,'iijlSion of a structure, or any change in the use ofland or structures
requested by this application will comply with, and conform to, all applicable laws ofthe St!Y;;H~ tlii:OI~:Iilil'!)N~tjiJ"r100Iiana - 1993"
(Z-289) and amendments, adopted under authority of LC. 36-7 et seq, General Assembl~I9.tollf~~~fifI~t~Il({j'6:i'io. I further
certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify tb,tS9llfl!'l!i!rn<I!?JPa~le~J>.'i~~d'3r ~mlpied until a
Certificate of Occupancy has been issued by the Department of Community Services, ~ 'eJP~.~flAf ."..-.-'y 6!1
,D ' , _ ",;,. ""-'" , ~~aX!r."'~
~ ~ tjdi4L\r(XC.CITY OF ~~~P9~~~'''tmVNS~:!!'
Signature of Owner or Authorized Agent <J FootinglUnder SIWJI~gh-In Meter Base
..
L\t'\.c\.CL \<--c..Q.c..h
(Print)
Site
"'''''=, i
Base Inspections'
Cert. of occupancY:~
P.R.I.F.: , I.;
TOTAL: 1f-
Final C/O
. Sq. Ft.1 q~3
'7/);1,.30
51S~d350 -'\ ';;}'\)-
(Phone Number)
E-Mail:\\~.\L-cOC........ 0-pu\k. ,~
/
Plan Commission/BZA/BPW Docket #'s; TAC Date(s)
30
Reviewed! Approved: Dept. of Community Services