HomeMy WebLinkAbout05040076-Application ~ Permit #
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family:'--"'" "~"New Structures, AddiUons, Remodels, & Accessory Structuras
BUILDER
RECORD:
PROPER~
OWNER:
& PRO3E~
(EXCLUDING LAND VALUe)
; ~zo3
ziP
~ COMMISSION / BZA / BPW
AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #~J (IF APPLICABLE):
[] SINGLE FAMILY
[] TOWN HOME
[] TWO FAMILY
# of units:__
C] MULTI-FAMILY
. # of Units:__
~ RESIDENTIAL(For
Additions, Remodels, Etc.)
TYP -- - R V -ENT:
[] NEW STRUCTURE
[]. ROOM ADDITION(S)
{~5~r PORCH ADDITION(S)
REMODEL
ACCESSORY BUILDING
DETACHED GARAGE
ATTACHED GARAGE
[] DEMOLITION
WhiCh
[] International Residential Code w/Indiana Amendments
[] Uniform Plumbing Code w/Indiana Amendments
(Multi-Family Consiruddon Code)
Manufactured / ~: (Check all that apply for the new
Permit: . Y ~ TrusSes: Y~
-- - . -- ~ [] CRAWLSPACE ~ POST&BEAM
Lot split: __ r_ Sump Pump. ____Y_V__N [] .SLAB / [] BASEMENT
Does any part of the pruperty lie within a special Flood designation area. Y _t/__N WALKOUT: Y N
the use of land or
aot be
Indiana.
~ Reviews
Cert. of Occupancy: ~~
~rcmodels,
within 180 days of the date of issuance c
I, the undersigned, agree that any construction,
stamctures r,~e~.~es~ed by r2Ms application writ comply with, and conform to, att:
Indiana- 1993 (Z-289) end amendments, adopted under authodt7 of I.C. 36-7 et sec
thereto. I further cextJfy that only kitchen, hath, and floor drains are connected to the sanitaz3
issued~
OFFICE USE ONLY: *************
REQUIREI
~ Lower Footing
P.R.I.F.: Additional Fees
TOTAL:
~f Community Se~ices i
Fee ReceDed by: