HomeMy WebLinkAbout05080205-ApplicationFor Single Family,
PERMIT APPLICATION
Additions, Remodels, & Accessow Structures
RECORD:
BUILDER'S EMA1L ADDRESS
PROPERTY nme
OWNER:
LOCATION
& PRO3ECT
INFO:
SUBDiViSION NAME
ADDRESS OF CONSTRUCT[ON
WATER UTJL!TY
PROVIDER:
NAME OF UTiLiTY EXCAVATION CONTRACTOR; PLAN COHMISSION
NUMBERS; TAC DATE(S); AJ~D/OR COUNTY WELL AND/OR SETTJC PERMIT #'S
~INGLE FAMILY
TOWN HOME
TWO FAMILY
# of units: []
MULTI-FAMILY []
# of Units: []
RESIDENTIAL (For []
Additions, Remodels, Etc.) [] DEMOLITION
PHONE
SQUARE
FOOTAGE:
ESTIMATED COST OF CONSTRUCT[ON:
(EXCLUDING LAND VALUE)
Ule new
issuaace date. Class I structure permits are subject to the General Administrative Rules of thc State of Indiana (See 675 IAC 12) regarding exp~rauon
time frames for beginning and completing construction.
J.Ai..~ 100~"/7 9ao'~audamea~dments adoDtedundexauthontyofl,C. 36-Tctseq GeneralAssemblyottneStateotmmana, anaaaActsam
~eret"'~g ] L~h~"~at o~y kkche.~, bat~, a~ ~qo[drains m c9~ ected m the sanitary scw~. l. fu~her, cert~ that, .dxe3onstruedon will not me:
-- '" "-' .... ~ate o[Occu~ [fe~ [~Jl~Depaxtment of Commumty ~,erwces, I..armet. lnoaana~ .~. / --/
OFF~CE USE O · ****************************************************************
Lower FooUng
~ou~'%~M~t~'~B~s~Rou.h '& F:nal Site
(Date)
Filing Fees:
Base Inspections:
Cert. of Occupancy:
P,R,I.F,:
# Charged Re-
Reviews
Additional Fees