HomeMy WebLinkAbout07060256 Application
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C't ifC IIC" 'T' h' Permit #: ()70&n7-.s/
, y 0 arme lay .I. owns 'P I 4?
COMMERClAL/INSTITUTIONAL/MULTI-FAMIL Y IMPROVEMENT LOCATION PERMIT
APPLICATION (For New Structures, Additions, Remodels, Tenant Finishes, &. Accessory Buildings>1
BUILDER
OF
RECORD:
PROPERTY
OWNER:
LOCATION
& PROJECT
INFO:
PHONE: FAX:
S'f(.-78"'-
STREET ADDRESS:
CITY: STATE:
ZIP:
'1"0
BUILDER'S EMAIL ADDRESS:
'"
K
~
STREET ADDRESS:
ADDRESS OF CONSTRUCTION:
BEST METHOD OF CONTACT:
CITY:
STATE:
ZIP:
SUITE #: (If Applicable)
5"00
Sr.
Lot # and S~bdivision: (If Applicable)
Address of Shell Building: (If different than Address of Construction)
BUILDING, PROJECT, OR TENANT NAME:
S.nr
STATE COMMERCIAL
DESIGN RELEASE #:
ZONING:
C:..3
o STR ~RCH p<::MECH
o SPKLR OTHER(S):
WATER UTILITY
PROVIDER:
3'ZG. 728
t
SQUARE
FOOTAGE:
12.00
t'T
ESTlMATED COST OF CONSTRUCTION:
(EXCLUDING LANO VALUE) .If 30, OOC>
SEWER UTIlITY
PROVIDER:
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERMIT #'5 (If Applicable):
# of Floors:
Elevator or Lift: 0 YES X NO
BLDG. CONSTRUCTION TYPE:
TYPE OF CONSTRUCTION: TYPE OF IMPROVEMENT:
~ COMMERCIAL 0 ~~W STRUCTURE
(Privately owned hospitals and medical r~ ('JABDmON
offices/centers are commer,cian r--rr:,,\JV ' '.- ,\.G] Room(s)
o INSTITUTIONAL .... CCI\'\~ \,~ <12.c;,).;<.",(J 10 Porch
o Jj~IE!~ap&Jf5"c Bldg;/n ':Ji'" .p Mezzanine or Deck
...(:$ flitllOOt' '",I (;8 " "\ CC/)e5tREMbD~l
~\::eCI=~rOV~~ nl") \.'-"';' 'I sC ,_,NEI'!'i!'ENANT FINISH
o ~~AM!l9\",t-' -"~!1U~ ,II .," ' ,j\/l:dESSORY BUILDING
Number o'()~=()\~; I c,\}'- 1 \ 0 DETACHED GARAGE
FOUNDAT ~ 'Iro/ll'~\"lr h' '1\" 0 ATTACHED GARAGE
'1.>1"" C. ~ ''''',,'~ I 0 CEll TOWER (New)
apply for e~ onstruct,onllrfea) 0 CEll TOWER CO.lOCATE
~LAB 0 CRAWL SPACE 0 DEMOlTTlON
o POST &_BEAM _PIER 0 BASEMENT (WAlKOlJT:_Y_N)
OCCUPANCY CLASSIFICATION:
PROJECT INFORMATION:
Early Release V
Permit: _Y ~N
Lot Split: _Y XN
Manufactured
Trusses:
Sump Pump:
_ Y )<"N
_y;lN
FlOOO ZONE AREA DESIGNATIONISl FOR THIS PROPERTY:
)(
.
u/l15fy,tI1rf ~
PLUMBING CONTRACTOR:
~A 1A.l>Y MeL1fAI'J/CAL-
Plumber's Indiana State License #:
c.os-o~a::q ~/----~-----'I
j-- \
Class I structure permits are subject to the General Admini Ive Rules of the State of Indiana (See 675 lAC 12) regarding expit:ation time flameSfcir~;in~-~d~ \
. ". completi.ng construction. \ :-1 I' ' \ \ \ "
I, the underSIgned, agree that any constructIon, reconst cnen, enlargement, relocatIon, or alteration of a structure, or any change .rnt~e use of land or spue;tur\~ n(l\lested by " \
this application will co 't ,and conform to, al pplicable laws of the State of Indiana, and the uZoning Ordinance of Canne}ilndiaha -19$J~~2A:9) 4Ad alWelddmems, )\J : '
adopted under au no.. -7 et seq, Gene Assembly of the State of Indiana, and all Acts amendatory thereto_ I further certify that only1dtchen, bath, and floor drams are
connected to t sanit er. I funher cer' that the construction will not be used or occupied until a Certificate of Occ~P:mcy or Substantial Completion has ~~ri
i"u,d by tho 'pan , C mmunit]( <vim, Carmd, Indi=a II
:5"I:>l-l-N lttIEfL~€()I., ~/lS/-ZOC7
Print Date
OFFICE USE ONLY: ****************************~.*********************:1********************
INSPECTIONS REQUIRED' Filing Fees: 5-3 y, 00
lower Footing u'nder Slab Base Inspections: J.. 0 ~ , DO
~ ert. of oC,"c c~u ancy: / I I . () 0
Meter Base ~ Site ./
L' 3,
~,
ee Received by:
Upper Footing
Rough In
Reviewed/Ap oved: Dept. of Community Service
S:PermitsfForms/IL COMMEROAl
Date
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