HomeMy WebLinkAbout05090052-ApplicationRECORD:
PROPERTY
OWNER:
Permit #:
J or Znstitutionah New Structures, Additions, Remodels, Tenant finishes, &Accessory Buildings
NAME PHONE ~ FAX
Address of Shelt Building (If different t~an Addres~ of Construction)
SCOPE(S) OF
RELEASE:
PROVIDER:
AND/OR
PERMtT #'S (Ii' Appllcabte):
YE~ [~ NO BLDG, CONEFRUC'E[ON TYPE:
COMMERCIAL
(privately owned hospitals
and medical offices/centers
are commen:lal)
.P- : -. -_VEM--.i :
[] ADDed'ION [] Room(s)
[] Porch
NEW 'TENANT I
~CUPANCY CLASS[
Perm~
Lot Split= _Y.
a special Rood
Plumber's Indiana State License #:
Upper ~ung