HomeMy WebLinkAbout05030199-Application LJ ~' '~'~ Permit#:
S[DFNTbLL ] [P CO E NT LOCATION
For Single Family, M-Itl-Family, & Two Family: New Stractures, Additions, RemOdels,
RECORD:
PROPERTY
OWNER:
PHONE
ZNFO:
SEWER b33L~TY ~
PROVIDER: ~
WATER bT~LTTY
PROVIDER:
J3~LITY EXCAVATION CONTRAC'R3R; PLAN COMH[SS[ON
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMTF #'S (IF APPLICABLE):
~ SINGLE FAMILY
[] TOWN HOME
[] TWO FAMILY
# of units:
MULTi-FAMILY
# of Units: _ _
RESIDENT~L (For
Additions, Remodels, Etc.)
~ NEW STRUCTURE
J C~ ROOM ADDITION(S)
[] PORCH ADDT[ION(S)
[] REMODEL
[] ACCESSORY
will be applied to the construction:
a Amendments
B w/Zndiana Amendments
r for I~e new
i area)
[]/. POST & BEAM
I designation area. y_~__N WALKOLrr: Y ~/~N
OFF~CE USE ONLY: ******
Services
(Da~e)
****************************************
:ees: ~
~~ # Charged Re-
pancy:
P.R.I,F.: ~ Addi~onal'-~'~