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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: ~