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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-