HomeMy WebLinkAbout05030063-Application Permit #:
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
PHONE~ -- F
BUZLDER
of
RECORD:
PHONE FAX
PROPERTY
Lo~a~ L~ g SE~ON ZONINg;
& PROJE~ ~ ~ I
1'NFO:
WATER UT[L1TY
PROVIDER:
NAME OF brrlL1TY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #~ (IF APPLICABLE):
SINGLE FAMILY
I TOWN HOME
[] TWO FAMI.L.Y
# of units:
C] MULTI-FAMILY
# of Units:
[] RESIDENTIAL (For
Additions, RemOdels, Etc.)
i .- .F - _-=; - - :
~ NEW STRUCTURE
[] ~OOM ADDITION(S)
[~ PORCH ADDITION(S)
[] ~EMODEL
[] ACCESSORY BUILDING
[] DETACHED GARAGE
[] AI-I'ACHED GARAGE
[] DEMOLITION
Which plumbing code~
.~ Zntemational Residential Code w/Zndlana Amendments
[] Uniform PlumbingCodew/ZndianaAmendments
(Multi-Family Coflstru~on Code)
OFFZCE USE ONLY:
bl . _ __ ~:.~JJ~]~: (Check all that apP y for the new
anuta.czurem~/,, , /~oes.nstructionarea
Trusses.
~ ~N Sump Pump: ~__Y N ~{ S~'~:~
part of the prePerty lie within a special FIOOd designaflon a/~rea: y "~t~Y~nd,~,de~. ~'~N
For Single Family and Two Family dwellings, additions, remodels, and/or accessory stru~~~.t~b9
within 180 days of the clare of ie~uance of the building permit, and must be completed (~cCt~ bf
issuance date. Cla~ I structilre permit~ are subject to the General Admini~t rative l~ules of the State of Indiana {~ ~r~ }~ 12) regarding expiration
time frames for beginning and completing construction.
I, ~e u.dm~ed, am~ a~t an~ co~,=mo~, ~o~ _=cm~, ~m~t, ~aoc~o~. o, a~m.o~ o~
sWaceares Iequested by this alalalication will comply with, and conform to. all a of the State of Indiana, and t..he Zomu. g Lmamance ol Carmei
hldialla - 1993' (Z-289) and amendmealts, adopted under authority of I.( Assembly of the State of Indiana, and all Acts amendatoly
thereto, I furthex certify that only kitchen, bath, and floor drains aze con sewer. I furtbe~ certify that the ,c, onstraction will not be
med C ma,
Signa~re of Ov~er or Authorized Agent Date
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Filing Fees: