HomeMy WebLinkAbout03080139 Application Cannel/Clay +\-AW V 1 S or- ,
Township Application for Ot .o (L 7)7
Had#:—'. Improvement Location.Permit Date
Roll File
This permit is valid only if construction is started within 180 days of the date of issuance for residential cons - non;and for commercial projects,within one(I)
,year of the date of issuance of the State Commercial Design Release. All construction must be complete d (c/o issued)within 2 years of the issuance date.
NAME I'f I(f / PHONE FAX
BUILDER' EL4M T OM cik-c'G✓at�o 8-k(c -379' b E - 3 79
'STREET _ r CITY STATE ZIP
597 .---L-Ct441WitraV Sikl le 1°4 (_A-r.ne 1 CL3 4(003 Z
TENANT NAME
Of applicable)
NAME /,_ P NE FAX
OWNER it
STREET CITY STATE ZIP
LOT SUBDIVISION SECTION _
LOCATION 57 84 ote o( lei-) "f
ADDRESS OF CONSTRUCTION
434-73 e o& Moov' et%/cf e. //l1✓T2 L o37""
-
' A. TYPE OF CONSTRUCTION Do pla s'includea porch? F. TYPE QF'IMPROVEMENT
I. A Single Family VIYes.❑No 1. Z New Structure
2. ❑ Two Family 2. ❑ Addition: Po¢h=Room
3 ❑, Mulh-Family Type of Foundation 3. ❑ Remodel ®.Commercial Tenant S a e
4 ❑ Commercial•I.Industrial ❑ Crawlspace 4. ❑ Foundation O y
5 ❑ OTHER 0 Basement- 5. ❑ Demolition EOOZ j g 91W
(Specify) 0 Slab 6. 0 Accessory Bu�r-l��,n�gg--�� gg,.,,_,,��
B. SEW: 7. 0 Garage DetacAe7l �n ?lip A��
1. Public (Natne,of systemaliStJP )
2. ❑: ,Private(County permit'# ) G. Lot Split YES NO .."
C. WATER: H. Flbod-Zones YES NO ✓
1. '❑ Public (Name of system W G ) I. Sump Pump YES NO
2. ❑: Private;(County permit#- ) J. Manufactured Trusses YES NO
G�17� t/
D. ZONING : S"1 K. Plumbing,Contractorr 7 i a �E.
i#
.
E. ESTIMATED COST OF CONSTRUCTION IRC Plumbing Code:, Plumbers.,. ry.
(Excluding Land Value) 110 000 Indiana Plumbing Code: ❑ License#i•`R:p,e)(0 01349
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I,the undersigned;agree that any construction,reconstruction,enlargement,relocatlgrrrciair 0e, si,way & -nal,�land'enstructures
requested by this application will comply:with,and conform to,all applicable laws offt�'ic State o an on n ce o''FCC"armel Indiana-1993"
(Z-289)'and amendments,adopted under.authority of I.C. 3O-7 etseq,General Asse �thj, AVM .,�ainiRa rRmendato thereto 1 further
certify that only kitchen,bath,and floor drains are connected to the sanitary sewer. I tYrhe1'ti -an
t t c n RMAGNNroccupied until a
Certificate of Occu ancy has be "sued by the Department of Community Steth Y,';OFncARta EL. 1 CLAY TOWNSHIP /
IN"S` dE YSNSNEEDED:
Signature of Owner o vthcri A nt ootitig nder . , 'ou_h- '' eter�B se
® _ :r7
1 C s
�I VII /// Sq.Ft.
(Print) (Phone Number) ./ O/ 7 70
I, 1 Filing Fees: / ti
E-Mail: Clt1✓)e i∎t °, P1'I&W�l kt "Cent'\ Base Inspections: rr77
Cert.ofOccupancy: c7P, CO
PRIR: 2Y, Cd
Plan Co r�: : • Docket#'s; TAC'Date(s) /
�I TOTAL: //Ft Reviewed/App e.: Dept. of Community Services � e11 fill ' \ �S! orms/u.PS-02