HomeMy WebLinkAbout05090227-Application rmit #:
)C OI ' ERMIT ApPLIcATION
For Single Family. HulU-FaMJ~ ~l~l~{~eW StrUctures. Addi,ons. Rem~els. & A~o~ ~s
BuZLDERof .m~ ~n ~te V . ~ ~
RECORD: ~.;ss ~ ~
one 317-806-29 1 Fax 317-8 : 89
PROPERTY
OWNER:
PHONE
LOCAT[ON LOT #
& PRO3ECT ? -
INFO:
SECTION ZONING:
PROVIDER: L~4.q x~/~j~?~.~ (ID(CLUDING LAND VALUE) , ~'~/~
PRoVI.:
NAME OF OTILITY EXCAVAllON CONTRACTOR; PLAN COMMISSION
NU"BERS; TAC DAllY(S); AND/OR COUNTY WELL AND/OR SEPTIC "ERMYI' # S (IF APPLICABL~):
0 SINGLE FAMILY
(~ TOWN HOME
[] TWO FAMILY
# of: units:.
[] MULTI-FAMILY
# of Units:
[] RESIDENTIAL (For
Additions, Remodels, Etc.)
RH :
Early Release
Permit: ___Y _.~_~ N
Lot Split: ___Y __E_N
[] PORCH ADDITION(S)
[] REMODEL ..... ~
~~~~bl~ ~e w/~ndiana ~endmen~
Manu~r '~'~' D~D~At.~j~AFOU DA : (Ch~k all mat apply for the new
T~: ~Y __N ~n~on a~)
0 C~W~PACE 0 ~ & B~M
Sump Pump: Y '~N ~ S~B ~ B~EME~
Y ~N WA~O~: Y N
Does any part of the property lie within a special Flood designation area:
For Single Family and Two Family dwellings, additions, remodels, and/or accessory stracmres, this permit is valid only ff construction commences
within 180 days of the date of issuance of the building permit, a~d must be, ~ within 18 months of the
issuance date. Class I structure
time frames for beginning and (
I, the undersigned, agree that any constzuction, reconstruction. : f~ the use of land or
structures requested by this application will comply with, and conform to, ;~1 a Ordtr~ance of Cannel
Indiana- 1993" (Z-289) and amendments, adopted under authority of I.C. 36-7 et and all Acts amendatory
thereto. I furdaer cerdty that only kitchen, bath,
used pr occupied until~ Certi~cate o£Occupancyhas been issued' ' ' g~
nt Da~e
OFFICE USE ONLY: ************************************************************************
Filing Fees: ~
r Slab
(Date)
Reviewed/Approved: Dept. of Community Services
Base Inspections: ~ # Charged Re-
CeCc. of Occupancy: __~_~] ~ ~ Reviews
P.R.LF.: ~ L ~ 0 Additional Fees
×~ TOTAL:'' ~r~!~ ~ ] ~-~, 0 0 .