HomeMy WebLinkAbout05060020-ApplicationFor Si
of Camel~Clay TownsMl~
~J~"~ f~ Permit#
CATION
New Structures, Additions, Remodels, & Accessory Structures
PHONE ~. PAX
~'FA~I~ / ZIP
PROPERTY
OWNER:
STREET ADDRESS
PHONE
CTTY STA~
LOCATION LOT #
& PRO3ECT u~
SECT[ON
,~BD[V~SION NAME
INFO:
SEWER UTIL['~ ~ WATER UTILITY
PROVIDER ~_~ ~ ~ L~ ~ PRO~DER: ~
ZONING:
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION ! BZA / BPW DOCKET
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEFTIC PERMIT #'S (IF APPLICABLE):
[] TOWN HOME
[] TWO FAMILY
# of units:
[] MUL~-FAMILY
# of Units:
[] RESIDENTIAL (For
Additions, Remodels, Etc.)
PR- -~ - -- i: :,:
~-"~ EW STRUCTURE
~3 ROOM ADDH']ON(S)
Does any
OFF/CE USE ONLY: ***************:
Final
Services
I structu~ ~rmi~s er~ s~
AqTACHED GARAGE
DEMOLITION
/ ~[[~L~[.~: (Check all that apply for the new
Y construction area)
,/ [] CRAWLSPACE [] POST & BEAM
N
[] SLAB ~ BASEMENT
I Sump Pump:
m~
is valid only if construction commences
within 18 months of the
= o{ lnddana (See 675 1AC 12) regarding expiration
· ~ in the use of land or
General Assembly of the State of Indiana. and all Acts amendatory
i to the sanitary sewer. I further certify that the construction will not be
Services, ~ Indiana.
Fees: ~
~_~A~_7 Y 0 # Chained Re-
Inspections:
Cert. of Occupancy: ~~
P,R.I.F.: ~'.~'7. (f)O Additional Fees
~ TOTAL: /
[] PORCH ADDiTION(S)
[] REMODEL
[] ACCESSORY BUILDING wh.~b plumbing codes will be applied to the construction:
[] DETACHED GARAGE ~l~Intemaflonal Residential Code w/~ndiana Amendments
[] [] Uniform Plumbing Codew/IndlanaAmendments
[] (Multi-Family Constm~on Code)