HomeMy WebLinkAbout04010064 Application
-
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Township'
Hold#:
Application for
Improvement Location Permit
"-
Permit
Date
Roll File
This pennit is valid only if construction is started within 180 days of the date of issuance for residential construction; and for connnercial projects, within one (1)
ear of the date of issuance of the State Connnercial Desi Release. All construction must be corn leted c/o issued) within 2 ears of the issuance date.
1J~')\ N~E fvt
BUILDER ~1; \1' ,
New. ) Jey
&3 iJ- I
FAX
STATE
ZIP
- 1 "'~~
TENANT NAME
Ifa licable)
OWNER
NAME
tv\A ~ t10tLTbN
PHONE
FAX
B4<.->-LS'15
STREET
"80f N.~N6L"fd
CITY
I~ - .
~""e-I
STATE
ZIP
(/oJ
4c...O.sj"
LOT
LOCATION
i47
SUBDNISION
t-JDt..f"'wCoc:>d. #' Us .
SECTION
34-
ADDRESS OF CONSTRUCTION
't'OO4- N. \~_JV~~ e,.r;....e..f
A. TYPE 9F CONSTRUCTION Do plans inclu~I)Orch?
1. Q"" Single Family 0 Yes r3"No
2. 0 Two Family
3. 0 Multi-Family
4. 0 Commercial/Industrial
5. 0 OTHER
(Specify)
B. SEWER:
1. 0 Public (Name ofsystem~ C/ )
2. 0 Private(Countypermit#~ )
C. WATE~' ,
1. [!( Public (Name of system W~l
2. 0 Private (County permit # '"
D. WNING: ~-- /
I
E. ESTIMATED COST OF CONSTRUCTION IRC Plumbing Code: 0 Plumber's
(Excluding Land Value) 4OIoDD Indiana Plumbing Code: 0 License #:
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I/J ~O.U
F. TYPE OF IMPROVEMENT (,;2 7/
Type 9f Foundation
13'" ....Rrawlspace
~/f:Jasement
6' Slab
1.
2.
3.
4.
5.
6.
7.
o ;N"ew Structure . .) C / \.:::J;iJ
[!f Addition: Porch C:><ilorii .. .'
- -
o Remodel l(r:cj:all'enantBp.~ce
o Foundation. ;. .
o Demolition!
o ....Accessory ~uilding
13"" Garage Det: "
i: ..
Attached ~.
)
)
G.
H.
I.
J.
Lot Split
Flood Zones
Sump Pump
Manufactured Trusses
~.
YES ---:7'.NO_
YES """ NO
YES ~ NO--::--
YES - NO~
'NJA
K. Plumbing Contractor
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or alteration of a structure, or any change in the use ofland or structures
requested by this application win comply with, and conform to, all applicable laws ofthe State ofIndiana, and the "Zoning Ordinance ofCarrnel Indiana - 1993"
(Z-289) and amendments, adopted under authority ofLC. 36-7 et seq, General Assembly of the State ofIndiana, and all Acts amendatory thereto. I further
certify that only kitchen, bath, and floor drains are connected to the sanitary sewer. I further certify that the construction will not be used or occupied until a
Certificate ~~as been issued by the Department ofSowmunity Services, Carm~~."ndiana.
L (j-t...<.. - /1'/ /0 /,..~~ /:, INSPECTIONS
Signature of Owner or Authorized Agent / ') A 7tFoot9ig/uVder Slab
D' ....//VA (/ // I
I I ;[,t /7( '" I Site
{2j4- T1Ct2-~ g4~2b'1 i t./ I Jiil ~/ //
(print) (Phone N ber). 011 '. ~iI' /,/
./ V {I Img F!:i.es:
C u"...._ """"., ritt/-B'as~'i~spections:
(. S -......... y /
Cert. of Occupancy:
E-Mail:
/
S:Pennits/Fonns/ILP5-02