HomeMy WebLinkAbout05040206-ApplicationCity of tarred~Clay Township Permit #:
RES~ENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, HuRl-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER of
RECORD:
PROPERTY
OWNER:
STATE 2~P
BEST METHOD OF CONTACT:
~-r~_L/ o,~- c.e// ~ 3'7l -~7o~
PHONE FAX
~ LOT
_INFO:._
~ER~
NUN~; TAC DA~(S); ~D/OR ~U~ ~ AND/OR ~C PE~ ~ (IF A~):
TOWN HOME
[] TWO FAMILY
# of units:
E3 MULTI-FAMILY
# of Units:
C3 RESIDENTIAL (For
Additions, Remodels, Etc.)
- ' - _ VEM: :
)~ NE'~V STRUCTURE
ROOM ADDITION(S)
[] PORCH ADDITION(S)
[] REMODEL
PLUMBING CONTRACTOR:
r
Plumber's Indiana State License #:
Lot Split: Y--~'N Sump Pump: --~/~--N/--
[] SLAB
Does any part of the property lie within a special Flood designation area: y
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures,
within 180 days of the date ofiamlance of the building:
issuance date. Class I structure permits are subject to the General Administrative
rime frames for beginning
l, the tsadetsigned, agree that any construc~on, reconstruction, enlargement, relocation, or alteration,
srz'uctures requested by this application ~ comply with and conform to, all a
indiana - 1993" (Z-289) and amendments, adopted under authorit7 of I.C, 36-7 et seq, ¢
s of the
[ or
of Community
CerL of Occupancy: 0/'/- '~{~ Reviews
p.R,I,Fii .' ~ AddlUona, Fees
Fee Rece!veoVbv:
~erete: I further C~ that only kitchen, bath. and floor drains are connected tO the sanitary sewer. ]
used or cce~ u,!~ed nntil a. Cerr~a,~care o£ Occupa~c?has lx'en ~ued by the Depart~ ~t~Commu.c~,L~ indiana.
Signatul~ of Owller or'Authorj~el~Agent Prin----~ '- Date
OFFICE -S~: OuLY: *******************************************************~*****************
TNSPECTIONS REQUZRED: Fi!ing Fees: ~
Base Inspections: ~ # Charged Re-