HomeMy WebLinkAbout05110047-ApplicationOWNER:
LOCATION
Permit #:
INSTITUTIONAL IMPROVEMENT LOCATION PERMIT APPLICATION
II or Institutional: New Structures, Additions, Remodels, Tenant Finishes, & Accessory Buildings
PHONE FAX
.cc 5-77- oo 5-77-_oz- -Co
ziP
BUYER'S E~L ADD.SS ~ B~ M~OD OF CO~A~:
~ ADD~S ~ ~A~ ~P
SU~ · (If Applicable)
Lot # and Subdivision (lf Applicable)
5
TAX MAP PARCEL #:
FOOTAGE:
ESTIMATED COSTOFCONSTRUCT[ON~.-
(EXCLUDING LAND VALUE) ~
/ ~ (Privately owned
and medical offic~?ters
[] INSTITUTIONAL
[] Hunidpal~c~ ~lcj ,
TY = - :-'-VEMENT:
.~NEW STRUCTURE
[] &DDITION
[] Church ![ ' ' '
~ L)F ~}'i Cg' ACCESSORY BUILDING
~: (Check all which ~,~ [] DETACHED GARAGE
aPl~l~ for the new construction area) C3 ATrACHED GARAGE
/~' SLAB [~ CRAWL SPACE J[~ CELL TOWER (New)
[] POST & BEAM [] BASEMENT [] CELL TOWER CO-LOCATE
(or POST & PIER) WALKOUT: Y _N [] DEMOLrDoN
Early Release ¥ Man.~.~md ~
Permit: Y '"-N Trusses. ' ~ Y__N
Lot Split: _Y_~_N Sump Pump: Y/tC N
P -"_ =N '-_ -:
Plumber's Zndiana State License #:
ubject to the General Administrative Rules of the State of Indie. na (See 675 IAC 12) ~gard/ng expiration time frames for
begtm~g an~ completing construction.
I, th~ ~aeesiSnea, ~r~ that any construction, reconstruction, enlargeraens, =location, o~ alteration of a structure, or any change ~n th~* use of,l.~?, or strucm.re.s"
requested by this application will comply with, and cmffonn to, all applicable laws of the State o£ Indi~a, and the *Zor, Jng Ordinance or C ~m.e 1~ In ,di~a -
289) and amendments, adopted under authority of LC. 36-7 et seq, General Assem?y o£ the State o£ Ind~na, a~..d all Acts am?dator] tl}erem. !,m ~r~me5.c~r ray ~at omy
ldtthen, b~th, and floor drains are cormected to the sanitary sewer. I furthe~ certify that the constmctton will not be used or occupied tram
f the Depmens of Community Services, Carmel, Indian~
f Owner or Authorized Agent Print ~Date
Filing Fees: # Charged Re-
Base Inspections: Reviews
Cert. of Occupancy: /0...~ · t9
Additional Fees
t Services (Da~) Fee