HomeMy WebLinkAbout05070221-Application ~PPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
ORD:
PROPERTY
OWNER:
STREET ADDRESS
BUILDER'S EHAIL ~DDRESS
NI~qE
PHONE FAX
ziP
PHONE FAX
INF~: ~D~SS OF CON~U~ON ~U~
S~ J WA~R~ J E~OFCON~U~ON:
NUH~; TAC DA~5); ~D/OE ~U~ WELL ~D/OR SE~C PE~ ~'S (IF ~):
~ SINGLE FAMILY ~ NEW STRUCTURE
[] TOWN HOME C] ROOM ADDITION(S)
C~ TWO FAMILY [] PORCH ADDITION(S)
# of units:. [] REMODEL
[]] MULTI-FAMILY [3 ACCESSORY BUILDING
# of Units: [] DETACHED GARAGE
[] RESIDENTL~,L (For [] ATTACHED GARAGE
Additions, Remodels, Etc.) [] DEMOLITION
_ :-INF -',-~ :
Early Release
Permit: Y v/N
Which plumbing codes
~tntemational Residential Code w/Indiana Amendments
C~ Uniform Plumbing Code w/Indiana Amendments
(MulU-Family Construction Code)
~TYPE: (Check all that apply for the new
/ construction area)
Manufactured
Trusses: ~Y
LotSplit: Y ~¢/N ::= ~U:;p~j ~O~ ~g ~Sarea'LABC3 CRAW[SPACEy/N [~fl~ BASEMENT []~ .~DST& BEAN
Does any part of the property Ii i al d nation WALKOUT: Y ~NN
For Single Family and Two Family dwellings, additions, remodels, and/or accessory structures, this permit is valid only if construction commences
within 180 days of the date of issuance of the buffding permit, and must be completed (~a~y ~ ~f the
timcfm, mes for beginning and completing d~n~dt~~ - .-r ~ ~ .
L the unde~Jgncd, agree that any construction, reconsU'uction, enlargement, rdecation, or alteration of a :sumatra,ami, azj~ch~g~.i~d~s¢ of land or
structures ~:cquested by uhis application will comply with, and conform to, all applicable laws of rJ~ ~r.~ec~[;tndian~ ~d,fi~"~Z ~,n~u~¢~ Of (~annd
inct~ - 1~ (z.~8~) and ~ament~ ~dopt.d .nd~r aue~o~ty o£ Z.C. ~-? .t ~q aen~l
thereto, I further eemfy that only kitd~en, bath, and floor dnius ~re connected to the sanit~j~'*e.
u~cenpied u.~t~a~C.~¢u/~,~¢Y has been issued bY the Department of Community Services, ~}~'~T~t ~}~a,
Ts' ~'~°' °w"'~ ~ ~"~_°~_~-~ . P-"~__
OFFZCE USE ONLY: ************************************************************************
Filing Fees:
Base Inspections:
Cert. of Occupancy:
P.R.I.F.:
# Char~ed Re-
Reviews
Additional Fees
~ OTAL: 6~ °~ ~
Fee Received by: ~ ~ ~'
Under Slab