HomeMy WebLinkAbout0196.97 Application (2) �lay Permit No. ��Gyq
`�-'1�0� Application for, De� f �"�
" Impr,ovement Location Permir R°u F''e
This pe(mrt is valid..only if consVUChon is sfarted w�thin'.120 days of issuence.dale;sll consWction musCbe completed(c/a issued)wiUun 2 yeers of issuance,
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date.unlessan'extension��oftime.hasbeen�offie�all i-"ranted�,b letterti��theDiPectoi,De�artmentofCommuni Seivices.
NAME �PNONE FAX
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TENANT NAME
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SIAEET � . . CITY � SfATE TJP
S� rn e as a,�bv-L
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LOCATION °��J n' � n SW 00.'
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A: �F•CONSTRUC7'ION Do plans include a porcli'7 -E.. 1'YP OF IMPROVEMENT
I ' Single Family J�Yes❑No 1. J�New Struc[ure
2. ❑ Two FAmily 2. ❑ Addition Porcli_Room_
3. O ,Malti=Family Typ Foundation: 3. ❑ Remodel ❑ Commercial Tenant Space
4. ❑ Commercial/Industrial �rnwlspa 4. ❑ Founda[ion Only
5. � Earm �}3a5ement��� 5.. ❑ Demolition
6. ❑ OTHER OSlab 6. ❑ Accessory Bui(ding
(SPecSY) � 7. ❑ Swimming Pool
B. SEWE : 8. ❑ Garage Detac6ed Attac6ed
1. �Public (Neme of System �a �rnC � Lot Sp6t YES _ NO
2. ❑ Private(Septic Tank,etc:) % �� . ood Zones YES N�
C. WA R: p,�, , Pomp YES � NO _
�.
l. ��Pu6lio (Name;"ofSysteml.�,C�� ) J. utacturedTruasee YES � NO
2. ❑' Private(Well - 9J // 1l /� �
D. ZONING:�� � Plum6ing Contractor �d-P� �"�u h1YJ f l`�:�
E. ESTIMATED COST`OF CONSTR[3CTI � qJ�j J
(Excluding Land Valuej �D 00� j7n biug Iiicense tILPBb'8d�13s❑BOCA or 1�CAB0
*+#sss»*swstsi*t.�.*r*.r'i�+�"�ttsa*s.raaa+sis - �s.�s**s�x�#ti #ti►ik#tilR�itii#ii###rt#tii�ii*iktitittiiii
The undersigne,d agrees that any construction,reconsVUCtion; gement reloc ioa;or.alteration of swcture,or any change in the iise of land
or shuctures,requested by this'applioatron will comply witb,and co to,all pplicable laws of the State of Indiana,and the"Zoning Ordinence
of Cazmel Indisiia- 1993'(Z-289)and amendments,.adopted.under au ' � � I C 36-7�(et�sEq;�General Assembly�of the State of Indiana,and all
Acts emendatory.[hereto. I ftitlher certify that only kitchei�,bath,laundry,.end floor draiiu are conn�ied�to the,senitary sewer: I further certify
that`the rnnatn�ction will.not be use8 or cecu ` a " Occu ancy 6as'�beencigsued by ftierDepsyrfinenYof Commun3ty
SerVicea, Caruiel,Indiaoa a',�� .E(n1 j � �Ct,S ,.f�� ;rrr��t'o �i y''3/I tol/(
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� D P , a g- lo f�y� f%� ,, ecti ns'_�eed�, �ed'�alcrti�n:.
e1�.C�i`�2� l�-> . � c r, �."'t�a �.Tyn ���'��_
�� � io h�de'r'sISbF,Bou �-�,(�A¢e},e�tj je
Signatu`e of Owiier Authorized Agent ' . `f���Q(�d
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�GL�4l//1 i� 3�g'-�g8� e ?C1,Q�q c.t�
(Pruit) (Phone'Numhe[) Peimit(Square Foo[age)' �
'�Sewer Gapacity Allotted' � . Inspection Fees: � � S ��
Pian Commissio ,Docket#: CertiScate of Occupan y
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ewed/ pproved: Dept:of Community Services Fee eceived By s:��.sb m��s