HomeMy WebLinkAbout05090004-ApplicationCOMMERCIAL or INSTITUTIONAL IMPROYEMENT LOCATION PERMTr APPLICATION
For Commercial or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
BUILDER of
RECORD:
OWNER:
& PRO3ECT
ZNFO:
PHONE FAX
~0 _
PROVIDER:
PLAN COMMISSION / BZA / BPW DOCKET NUMBERS; AND/OR
COUNTY WELL AND/OR SEPTIC PERNIT #'S (If AP01icable):
#OfFJOerS: ./ Elevator or Li/t: ~1 YE~ ~1 NO
TYPE _F ~-- . _-_: , ' ; -.-:-~---NT:
~ COMMERC3AL *, ~- ...... C3 NEWSTRUCrURE
C~ INSTITUTIONAL~'~g~at[~- ~*r TM ] '( r :~:~ -'S [] Mo~anl~ or DecK
Lnurm ...... ~ t AC~':SSORY BUILDING
C] DETACHED GARAGE
[] ATTACHED GARAGE
C~ CRAWL SPACE [] CELL TOWER (New)
C~ POST&BEAM [] BASEMENT C~ CELL TOWER CO-LOCATE
(orPOST & PIER) WALKOUT: Y N C~ DEHOLITJON
ESTI~T~D COST OF CONSTRUCTION:
(EXO.UDING LAND VALUE) ,,~.,~.~ OmO
PR - , ~NFO ;-TI- N:
Early Release
Permit:. Y /N
Lot Split: ~_~N
Manufactured
Tresses: Y
Sump Pump: Y
Does any part of the pmper~ lie within a special Flood
designation area: __Y /N
Plumber's ~ndiana $tate Ucense #:
Class I seructuxe permits are sut~ect to the General Adminis~rgtive Rules of the State of India~ (See 675 IAC 12) i~ding expiration thne frames for
beginning and completing consmaction.
I, the undersigned, agree that any construction, reconstruction, enlargement, relocation, or akeration o£ a structure, or any change in the use of land or
r~questsd by t~s a~F~cati~n wi~ c~mP~y with~ and c~n~rm t~ a~ app~cab~e ~aws ~f the state ~£ Inddana~ and th¢ ~Z~ning ~rdinanc¢ ~f Carmd In~a - ~9~ 3
289) and amendments, adopted under authority of I.C. 36-7 et sect, General Assembly of the State of Indiana, and all Acts amendatory therero. I further certify that only
kitchen, bath, and floor drains are connected to the sanitary sewer. I further car tify that the construction will not be used or occupied until a Certificate o£
~c~u~Jancy ~ $ubstanr~M ~mP~ has been issu~d by th~ Department ~f C~mmuni~y Services~ Carme~ Indian~ j
Sl~naturffof Owner or Authorized A~ent Print Da~
OFFZCE USE ONLY: ************************************************************************
INSPECTIONS REQUIRED:
g Lower Footing Under Slab
Filing Fees: ~
/ ~ ~, ~,~ # Charged Re-
Base Inspections: ~ Reviews
Cert of Occupacy.n ' F) - ~ ~1
~ ~ / ~,~ ,~ ~// AddiUonalFees