HomeMy WebLinkAbout04120087 Application
City of Cannell Clay Township Permit #: flY-/ /2 V 0 ~7
COMMERCIAL or INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLIC1\.TION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
"
BUILDER of
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
NAME
Dl.A.Kt: Ce;JS'TIU n"A.! /-. p.
STREET ADDRESS -Ii
foOD t7J1-ST 1[;:-' ~ 172EFr rMrt (0()
BUILDER'S EMAIL ADDRESS
'Jl.+-+- VbLA- @. T>u/<C?~L-T ,COM
PHONE
3 - fJo8-UU
FAX
3q-8of:, -c':foZ
OTY
:LuP"'t,vA-; S
STATE
;r,.!
ZIP
""k>Z40
BEST METHOD OF CONTACT: e - M A-I L
NAME PHONE { ::r 08 ,- /fi, 2.1
OD M , dt , Ct-n r(ckO DEYilD Et-Ji!-, L, C,
STREET ADDRESS OTY STATE
000 E,45'i q",'Ij ~f{2.:FeT C;utrz- (0tJ :r;.,PI^ '{;..:IN
ADDRESS OF CONSTRUCTION
I D ,.,1;.A I cJ\-1 "\.A
Address of Shell Building (If dlfferen than Address of Construction)
S
FAX 311--80f:,-b]62-
ZIP
4hz.40
SUITE # (If Applicable)
""/-bD!f2-
BUILDING, PROJECT, OR TENANT NAME:
S '/. Vt 1Jc..f,';T M E'17/cM..-
STATE COMMERCIAL 3D0US- 0 ARCH 0 MECH .0 PLUM
DESIGN RELEASE #: ~." ~~ OTHER(S):
WATER UTILTIY-;r:tJP/kf\}/.Jf'O""S SEWER UTILTIY C-J..A.Y lovJ1JSi/l f ESTIMATED COST OF CONSTRUCTION: fit 3 Zoo oDD
PROVIDER: " PROVIDER:" u" ,,~ c."-' (EX. _elUDING LAND VALUE)' f I
'v M tJ,....,nv ",~'Tc;.. Vt'>'{ --
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNlY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Roors:
'2-
Elevator or Uft:
\i(YES
Q NO
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
~ COMMERCIAL '6(f NEW STRUCTURE
(Pnvate~ owned hosplpt,l~ "0" ADDmON
and medical offlces/ce/ia!ii;lEASED FOR CAl.'c!lOPl"l1),
are commercial) SUbject to . 'EJ~'il~uCTlON
o INSTITUTIONAL CompiJance '!'lith ~ Ile>i\
o MunlopalfPublil: B1d!L of State am1 LIlfId(j)~d !!J~lli s
o School OEP r OF COMfiJ~l'/Atlf,.f.I~I~H_ .
o Church CITY ()F (' r-O oil.v:stJirnINGS
FOUNDATION TYPE: (Check all WIilclt'ARMqg/ Ell@WN~
apply for the new construction area) IN DlANJ'IICHED GARAGt'HI P
is:[ SLAB 0 CRAWL SPACE 0 CELl TOWER (New)
o POST & BEAM 0 BASEMENT 0 CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT:_Y_N 0 DEM0LIT10N
TAX MAP PARCEL #: /7-1'5 - 0 rc - 0
-00 - 023.
SQUARE ~ / '7
FOOTAGE: i-fo f ~
'3
OCCUPANCY CLASSIFICATION: B
PROJECT INFORMATION:
Early Release Manufactured
Permit: _Y ~N Trusses: _Y ~N
Lot Split: _Y -X-N Sump Pump: __Y-X-N
Does any part of the property lie within a special FloJd
designation area: _Y X. N
PLUMBING CONTRACTOR:
j{,Ii'J~ H-t>e.-Ai NlE?tf4NICA-L
Plumber's Indiana State License #:
GP8f30oJif'IZ-
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 conform 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 e sanitary sewer. I further certify that the construction will not be used or occupied until a Certificate of
t.7ccupancy or Substantial C . h be issued by the Department of Community Services, Cannel, Indiana.
::;:r;.u..u 4- .'Dt:LA-l( /;2-;1-01:
pr~ Date
Revlewed/Ap roved: Dept. of Community Services
S:Permits/FormS/l COMMERCIAL