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05090101-Application
Permit ~ ? LOCATION PERMIT APPLICATION Remodels, Tenant Finishe~, & Accessory Buildings FAX STATE BEST METHOD OF CONTACT: ZIP PROPERTY IER: PHONE ZIP SUITE # (If Applicable} different than Address of Construction) SCOPE(5} OF ~DN RELEASE: c3 ELEC ZONING: PROVIDER: : PERMTF #~ (If Applicable): (Prlv~ owned hosp~ls and med,q:al of~ces/centers are commercial) C~ INS'ITrUT~ONAL C3 Munidpal/Public Bldg C3 Church SLAB C~ ADDTE[ON [] Room(s) [] Porch C~) Mezzanine or [ [] REMODEL ~ C] NEW TENANT FINISH [] ACCESSORY BUILDING C] DETACHED GARAGE ATTACHED GARAGE [] CELLTOWER (New) ot Split: designation area: Y PLUMB] - l- ' / Plumber's Tndiana State License #: :t to thc Genera] regarding expiation ~/me/rame~ for Acts srnend~tor