HomeMy WebLinkAbout05030039-ApplicationFor Single Family, Hulti-Fami y, & Two Family: New Structures, Addit ons,
Permit
BUILDER'S EMA~L ADDRESS
STATE
PROPERTY ~E
OWNER:
PHONE
INFO:
ADDRESS OF CONSTRUCTION
S~ER 0TILITY WATER UTILITY
PROVIDER: PROVIDER:
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKEr
~ERMIT #'S (IF APPLICABLE):
SQUARE
FOOTAGE:
(EXCLUDING LAND VALUE) J ~% (~.~
SINGLE FAMILY
TOWN HOME
TWO FAMILY
# of units:
MULTI-FAMILY
# of Units:
RESIDENT~L (For
Additions, Remodels, Etc.)
-P -F VM;N :
NEW STRUCTURE
ROOM ADDITION(S)
[] PORCH ADDiTION(S)
[] REMODEL
[] ACCESSORY BUILDING Which plumbing codes will be a
AFl'ACHED
DEMOLITION [~ Uniform Plumbing Code w/Zndiana Amendments
new
(Date)
Site
Cert. of Occupancy:
P.R,I.F,:
TOTAL:
~ Onarged Re-
Reviews
~f N
__Y ~ Sump Pump: y ~f []
__ N
property lie within a s rea:
y e aa e o[ msuance o! t~e b~g ~r~t. ~d must be complct~ (C~te o[ Oc~p~cy ~ed) I mon~ of the
~u~cc ~te. C~ I sinecure ~ ~e subj~t to the ~ Adminis~ve R~ of thc S~te of infliana/~ ~7~ ~ ......
1, ~e undem' -- -- ~e fr~ for ~nn~g ~d comple~g const~c~on. ----- ~ .......... xz) r~g ~rauon
~cm~ ~u~tedb~' a~ee~sa~t ~Y~ca~on ~ comC°ns~c~°n' m~ns~cflon,~ ~ rd~a~on. , or dt~a~on of a s~cmre or ~v_ c~ge ~ ~e u~ o f~dor
~.~. m~.~ - pp . ply ~,~dco~o~to,~app~blehwsof~eStateof~dthe~ o~n~...~r~ ~
o~ ~pie~ unfl a}q~te o[~cup~q~ ~n i~ued by ~e Deponent of Co~muni~ Se~c~ ~el. ln~ , .~
OFFICE U *****************
Filing F~s: ~
Ba~ Ins~ons: ~