HomeMy WebLinkAbout07060018 Application
06/04/2007 MON 16,21 FAX 317 574 7780 TOM OBRIBN MAIN OFFICE
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JUN-04-2007 MON 01:41 PM
FAX NO.
P. 02
llApps:l\doa_p"",,"\lEMFOMRY Jl1'lJWIl'CWOm..>pmo1~""~~dll ~OO7.cIoe
cm OF CAIl.MEL, INDIANA. DEPARTMENT 01' COMMUNITY SERVICES
TEMPORARY USE APPLICATION
FIREWORKS SALES OR SPECIAL EVENT
DMSON OF BUILDING AND CODE SERVICES
INC MPLETEAPPLlCATIONS WIll. bElAY PERMIT REVIEW.
APPLICANTI OWNER INFORMATION (pIEASE PRINT OR TYPE)
COMPANY NAME: /4111 o't3~lrJII ~HIt'l5~tR JG'P PHONE*: (3/7 ) 105- ,,"0(1
APPLICANT NAME: 111f1M4-~ f. O'Bttlel'/ I'AXfiI: (31'1) ,7<1- 778()
ADDRESSOI'APPllCANT: </(,'30 E. ,/(,1"u Sf' (A/Oft} IN ""2.~(J
. ADDil.US (,,111 STAlE ZIP CODE
PROPERTY OWNER NAME: O'/3tlfjN JlcLOIl'iGS t.u. PHONE#: ( ) S4-~~
ADDR.ESSOFOWNER: 5AfVl~
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STATIi
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TEMPORARY USE INFORMATION
D FIREWORKS SALES
5A-MG'
SAMG
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iI SPECIAL EVENT I
NAME OF BUSINESS/ORGANIZATION:
ADDRESS OFTEMPORAll.Y USE:
DATE(S)OFPROPOSEDVSE: Jw/fi.
DFSCRlPTlON OF TEMPOR.A1l.Y USE:
HOUasOFOPJ:RATION: f.Dt>A/Vl - ':/~fM
WILL THEnMPORARYUSEBEOlJTDOOl!.Sl YES or NO
WIll TIlE TEMPORARY USE REQUIRE A STRUquRFI (ttnr:. stand. or mobllt unit) @lor NO
IFSO,WHATTYPEOFSTRUCTUREANDlNDlCATESlZE: 1.0" 20 T6A1i"
("NOTE MOBIlE UNIT REQUIRCMENfS ON BACK") MOBIlE UNIT CERTIFICA TloN '#:
WUl. THE TEMPORARY USE umIUA nMFOMRY SIGN7 'reS or NO
C' NOTE 'IEMPORJUty SI~N lU!Q.UIlU!M!NTS ON BACK')
IF APPIlCATlON IS FOR FIREWORK SALES:
(pLEAsE lW'ER TO AIlDlTIONALAPPIlCATION Il.EQUWMEN"rs RlR rIREWORKS SALES ON BACK)
Will nre STRUCTURE BE USED FOR THl! SALE OF MORl'! niAN Soo IUlS OF flllEWO~S1 YES or' 11/.' k
DOES THE STRUCTURE ALREADY HAVE ASPRINKl.ERSYSTEM INSTAllED7 YES or NO n
HAS THIS STRUCTURE PREVIOUSLY BEEN USED FOR TIIE SALE OF FIREWORKS? YES or NO
CERTIFICATION AND NOTtes OF lNTENTTO COMPLY
I hereby ccrdIy that I m..ve <:he authority '" m.tlu! the for<goirlg appllcadoll, tlw the appllc.atiou all<! pllms filed.with the appllo.tlon "'~
=<. all<! mat the operadon """ o:onduc, of the cempo=y uoc: will confonn m the reguladOll< at the CanncllClsy %oDmg O<<lWalcc.
1" 1. ~h;1"'_ '/ 1 (;,h,~.. . I
'1g"'~pPlf"" l,u,~:;-~) SigJl2tU~ow;;er~)
OFFICE USE ONLY (DO NOTWRm IN)
P1:RMrr II!: 0
APPLICAnON REVIEWED BY:
REQUIRED INSPECTIONS;
C ELECTlUcAL (B&lClO C sl1E (p1ANNlNG) C fIRE DEPARTMENT
ZONING:
DATE: kJ .::r...; QJ.
PARCELl!':
Cd! (317) 571-2+14 to 5clledtlle Electrical to: Sit<: lnsptCtiollS
Call (317) 571.2600 to sohedulc Plze DepilIOlll!ll' 1'''P'''''1011
C$l04.00 (Site Tnspmlon Fee)
C$83.00 (SlgIl.l'ermit Fcc) )70 -0
TOT At PEES DUE: $ :J If. )
om QVIC SQUARI!
DE>Al.ThlENT OF COMMUNl1Y Sl!l<V!Q;li
em OF CAP.MJ;1, INDIANA
(.!I7)sn-14H
liJ/5/t>7 loJ.eeJ term Ol~y\ ~ /I.l<cu:l~ .. ~
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06/04/2007 MON 16:21 FAX 317 574 7780 TOM OBRIEN MAIN OFFICE
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