HomeMy WebLinkAbout05100027-Application RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
For Single Family, Multi-Family, & Two Family: New Structures, Additions, Remodels, & Accessory Structeras
NAME ' , ~ · PHONE ~
RECORD:
CITY STATE Z~P
BUILDER'S EHAIL ADDRESS
NAHE~
PROPERTY C'~ ~, ~__Y
OWNER:
[] SINGLE FAMILY
[]TOWN HOME
TWO FAMILY
# of units:.
MULTI-FAMILY
# of Units:.
[] RESIDENTIAL (For
Additions, Remodels, Etc.)
= - ~--_ - i_- -_:
[] ROOM ADDITION(S)
[] PORCH ADDITION(S)
[] REMODEL
[] A~ESSORY BUILDING
[] DETACHED GARAGE
[] ATTACHED GARAGE
DEMOLiTiON
TRACTOR:
Plumber's Indiana State License #:
/~hznPlU mbing codes will be applied to the construction:
temational Residential Code w/Zndiana Amendments
C~ Uniform Plumbing Codew/~ndiana Amendments
(Multi-Family ConstrudJon Code)
Early Release / Manufactured // , new
Permit: Y_.~.._N Trusses: Y V N
Does any pa~t of the property he w,th,n a spec,al Flood designat,on a~T~)~'~t~,V~:t ,~ cWA~O~cff~?, ~,; _N
For Stogie FataLly Md Two Fan~y dwdJt~gs, adcLt~o~s, ~modeL~, aad/o~ accesso~ s~uc~t~, tt~s p~r~t b'~)~ coastmcr, to~ comme~¢~
w~t~. 180 d~ oE the da~e o[ ~ace of the b~g ~, ~d mu~ ~ com~]ct~ (C~te of Oc~cy
~u~ce dat~ Cl~ I s~c~ ~ a~ subj~t to ~e ~ Ad~a~ve R~ of ~e S~ of In~ana (See 675 ~C 12) ~g ~adon
: ~e f~ for ~mg ~d compledng cons~cfion.
I, the undersi~, ~ee ~t ~y cons~cfio~ r~ns~c~o~ ~em~t, ~ocadon. or ~t~a~on of a s~c~re, or ~y c~ge ~ ~e u~ of ~d or
s~c~ ~qu~t~ by ~s app~cadon ~ comply ~, ~d co~o~ to, ~ app~bie hws of ~e S~te of M&~ ~d ~e ~Zo~g O~ce of C~d
~ - 1993' (Z-289) ~d m~ts. adopted ~d~ au~o~ of LC. 36-7 et s~, G~ Assembly of ~e State of ~. ~d ~ Acts am~to~
· ~, I ~r~ ~ ~at o~y ~tch~, ba~, ~d fl~r &~s ~ co~<~ to ~e s~t~ sew~. I fu~
u~ ~pied un~ a~ce ofOcc~p~cy~ ~ i~ed by ~e D~ent of Community Sedco, ~el, India.
O~CE USE ONLY: ****** ***************************************************************
. ~ Filing ~:
.S.E O.S
~~~ ~' ~Ins~ions' ~
~p~r F~fin~ ~wer ~ ~a~ ) ' ~ R~e~
Ce~. of ~cupan~:
TOTAL: